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HomeMy WebLinkAboutBuilding Permit #637-2016 - 50 HIGH STREET 5/1/2018 �doFtYp♦ AWS f`Y�t BUILDING PERMIT TOWN OF NORTH ANDOVER ® , •;� rte},rv• •h APPLICATION FOR PLAN EXAMINATION Permit ® ; Date Received �1A0co- SS9CHUbl Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION - Pr fPN®,-P,�E-.RTY a W7XER �Cr 77 n pp Year S ruclu dyes no r oq ,.Y-- Histone D str c e. MAP PARCEL; Z®NINGDIS RIC ,_ o Machine S-JIE)is, e e no ` P .,.�..g. -.(M TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other _ ® � � Flood Iain ❑ Wetla�'�s FESeyt1Wellc ❑ '' I�i�p, .� _ .� z�_a � Watershed Distr'et °" DESCRIPTION OF WORK TO DE PERFORMED: . 7-1 0 A- cJ cfYJ c� 0 L�..c� IZ Identificati - Please Type or Print Clearly OWNER: Name: tG�'�u G3 �-�r Phone: Address: o iG1� t o V �' l -•v'�'�o - °�o-c'u ri�� ur 0-7-l �' -- -e .s. _ .=mow . �- Conga• ctorJ Name _ f kh-onei � .---- �.�;•cs� �.�--.�-�`°'.�.� `�:�f ""U:e: Supery►,i_sorr-sC�onstZENei@—n,3fcen _ Home Ilmprove ,e Lice se. -= ARCHITECT/ENGINEER Jt9s of 141'rTl(S�6V-tw� Phone: 6 n Address: d n n I'4tI" t �I "�7 Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ H ()0 FEE: $ �— Check No.: /� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar And Signatur.'e'of'Agent/Owier o _igrature`of,coritractor : ._ �-- Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimnin i Tanning/MassageBody Art ❑ g 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 i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Manning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Dafe Driveway Permit DPW Town Engineer: Signature: Located 3.84 Osgood Street f ``""`_ """rt"t. s� �tx.. iarcY ,�<e,o• ,.; : F,IRE DEP�'RUTMENdT. emp ©um stereonssiteRn esu;;: .. ,- . , p 4 .f Y t Located at 124 Mam Sfreet� ="� "'' k{� x�" " ''"" ""� Fire Departt,,6,,_j_v1sVignauref ` 7:Yi`� } e t #G 'A' COMMEIVT�S' r + 0.1 NORTH 6 O Dimension H TED n m Number of Stories: Total square feet of floor area, based onSSAc""S�� o .'® —1 Total land area, sq. ft.. oy ELECTRICAL: Movement of Meter location, mast or service drop requires , Electrical Inspector Yes No DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit 1 ❑ Photo Copy of H.I.C. And C.S.L. Licenses f ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And i Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products ®TE: 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 ATE: 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 clerlo 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 i . Location No. W �So Date • - TOWN OF NORTH ANDOVER e, Certificate of Occupancy $ Building/Frame Permit Fee $32 "_ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ „� Check#,!/" 1 29718 Building Inspector NORTH own of . Andover No. zY y *h 5 o ver, Mass w► � COC MICHI WICk �1' Z1,9 AO"tA S V . BOARD OF HEALTH PER..Ml LD Food/Kitchen Septic System THIS CERTIFIES THAT . �� 5 �4�. .*.IA..11 BUILDING INSPECTOR ........ ... ...... .... ..... ..... .... .................... AA Foundation has permission to erect .......................... buildings on ..%.. !eIS Z&t*A*.... ......... ...... • Rough to be occupied as .. �... ...�ll�R.. .. .... ��..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the-application Final on file in 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 INSPECT VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough ' t �(�ho Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ............ ..... .......... ,...V.......................................... Fin BUILDING INSPECTOR ?'/ GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. � �iORTh own oE Andover No. � 2 - °�Ah ver, Mass, w► ��J U BOARD OF HEALTH PER..MIT Food/Kitchen THIS CERTIFIES THAT ........ .• Septic System ... .. .. -...i risk X11.. ... - A... "•••••ew.......... .................. BUILDING INSPECTOR has permission to erect ....... buildings on ..% Foundation ' ...... to be occupied as �/� .......................... • ...� Rough Provided that the person accepting this ermitshal ' • ... . .. .. ....�� „ ,11� on file in this office, and to the provisions of the Codes and y-aws relating every respect conformto theto eIns a of the application Chimney Construction of Buildings in the Town of North Andover. g Inspection,Alteration and Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO TARTS ELECTRICAL INSPECTOR Rough ............jz Service BUILDING INSPECTOR• Final Occupancy Permit Regired tO Occuy R";1-1;-- GAS INSPECTOR Display in a Conspicuous Place on the Premises — D Rough o Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by-the BuildingInspector. FIRE DEPARTMENT petor. Burner Street No. Smoke Det. AcG CERTIFICATE OF LIABILITY INSURANCE 3215 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERnFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ss)must be endorsed. 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 endorseme PRODUCER W.Fr Maria Dupont Insurance Agency, Inc. P E 17 376-079 (617) 479-9121 1S Copeland Street me@dupontinsuranceagency.com Quincy, MA 02169 INSURE S AFFORDING COVERAGE NAIL• INSURERA:Main Street America INSURED INSURER 0: JR Contracting, LLC INSURetC: 31 Richmond Street INSURERD: Weymouth, MA 02186 INSURER E: INSURER F.- COVERAGES :COVERAGES 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPE OF INSURANCE AML SUM POUCY NUMBER LUM LINM A GENERALLUUwW MPT7794M 2/10/15 2/10/16 �DAMAGE OCCURRENCE $ 1,000,000 X CCMMERCIALGENEPAL LIABILITY renoel $ 500,000 CLAIMS-MADE F7X OCCUR MED EXP(Ary one persm) E 10,000 PERSONgL&ADVINJURY $ 11000,000 GENERAL AGGREGATE E 2,000,000 GEN'IAGGREGATELIMITAPPUESPER PRODUCTS-ODMPIOPAGG S 2 00,000 POLICY LOC $ AUTOMOBILELIABBJTY aactl nt $ BODILY INJURY(Per person) i ANYAUTO ALLOWrED SCHEDULED BODILY INJURY(Per accident) S AUTOS Op OVMED P ERrY DAMAGE $ HIREDAUTOS _AUTOS eraoddeM $ UMFIELLALJABOCCUR EACH OCCURRENCE S EXCESS LU16 CLAIMS-MADE AGGREGATE $ -F DED RETENTION WORKERS COWENSATION VYC STATU- OTH- AND,EMPLOYERS'LIABILITY ANY,PROPRIETORIPARTNERIEXEi%1TivE —I NIA E.L.MH AC CENT RI MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE IMardslory In NH) Mye$describe under E.L.DISEASE-POLICY LIMB DESG�RIPTION OF OPERATIONS below CESCRIPTON OF OPERA=W I LOCATIONS I VENCLES(AMadr ACORD 101,AddMlonsl Retort Schedule,Bmom apace Isregrlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU7HOR2ED REPRESENTATIVE Bridget McGowan 01985 2010 ACORD CORPORATION. All rights reserved. ACORD 25(101 W05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com `. 3/3/2015 7:22:03 AM PST (CAST-8) FROM: 100005-TO: 56174' 9121 Page: z or z Co CERTIFICATE OF LIADILITY INSURANCE 015 THIS CERTIFICATE IS ISSUED AS A NATTER 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: N the certificate holder Is an ADDITIONAL INSURED,the policy(ins)must be endorsed. If SUBROGATION IS WANED,subJed to the terms and conditions of the policy,carfain policies may require an endorsement. A statement on this eertNkste does not eonrw rights to the Call holder in lieu of such endorsame s. PRDOLnEIt DUPONT INSURANCE AGENCY INC 18 COPELAND ST PHONE FAx QUINCY,MA 02189 INSUROMANORDINGOOVERAGE Mac e Pa A: Liberty Mutual Fire Irsurance 23035 JK CONTRACTING LLC "a 31 RICHMOND STREET WEYMOUTH MA 02188 NaURER E: COVERAGES 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LJMR'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IINIIINn TYPE OF Ne1AtANOE E M COMMERpAL GENBIAL LMLfIY EACH OCOURRENCB S OLArAS-mAw F-1 OCCUR MED Ew one S PERSONAL&ADV INJURY $ ORA AGOMOM LIMIT APPLIES PER: OENERALAGGREGATE $ POLICY R& LOC PRODUCTS-CCMFlCPAGO S OTHER: $ Aurckow.E wAum : ANY AUTO BODILY INJURY(Per pmw) $ ALL DLED BODILY INJURY(PerAUTOS AUTOS ecddett) S E HIRED AUTOS � _ s iMIaRB1A LIAROCCUR EACH OCCURRENCE S EXCESS LL9a C Apd 404 AOOREGATE A rrDls�Ts oDtsefaATsm - 3601 698-015 712015 7 16 AND EMPLOYERS'UAILFrY MY PROPRIETORIPARTNEPA MCUTNE YIN E.L.EACH ACCIDENT S 100000 OFFICERIER MEMSEXCLUDED7 ❑Y N!A (Menddwy In Wry E.L.DISEASE-EA S r 100000 M deeerbe under Sf:RP71CN OF OPERATIONS bebw I.L.DISEASE•POLICY LIMIT 500000 DESORPTION OF OPERATUM/LOCATIONS!VMCM(ACORD 10f,AdM"I RmmMs 9chmU%neer be o8md*d K:mre spew b regLdmQ I Worfaers COmpereat:insurance oovarspe applies only to the workers canpensdon laws of the State of MA. This caditicate cancels and supersedes all previously Issued car6ficatse,only ae they relate to workers comperwallon coverage. CERTIFICATE HOLDER CANCELLATION TTHEULD MW M�DAET THEREOF, WILL CANCELLED09DELIVERED M MEMO ACCORDANCE WITH THE POLICY PRDOYIBLONO. ,.- ;��'4 .. AUTng11RED Liberty Mutual Fire Insurance {+ (`lJV'� ,J +_vw16},C'• 01968.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are reglsterad marks of ACORD CERT NO.: 23677622 CLIENT 0008: 1644469 Lucy Gwfield 3/3/2015 10:19:07 AN (EST) lag* 1 of 1 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELANt r 31 RICHMOND S7,0,, WEYMOUTH MA ,y - ,-, ., �, )I q.�I" CA— Expiration: ' Commissioner 09/26/2017