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Home My WebLink AboutBuilding Permit #175 - 50 PARKER STREET 9/1/2009 BUILDING PERMIT NORTH q ttt LfD 16� �O f J� TOWN OF NORTH ANDOVER ��tb;y''.- o� / APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received L9gDgATfD 4`� Date Issued: / SSACHU`-+�� IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes!Machine Shop Village yes CO 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) /3 OWNER: Name Z Phone:� � Address: CONTRACTOR Name: G Phone: -�- Address:- Supervisor's ess:Supervisor's Construction License: { Exp Date: AGlf Home Improvement License: Exp. Date: A,?�X ,f ARCHITECT/ENGINEER Phone: Address: 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: $__1z FEE: $ 2Z Check No.: ZZ Receipt No.: �Za3d NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i nature of Agent/Owner Si nature of contracto ,.r 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 �—k Z.)nin91Aoard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Vy 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 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 Doc.Building Permit Revised 2009 I ' 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 ' f 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 Doc:Building Permit Revised 2008 _-10 t.A1'[ON SMOKESTACKS ISUMITCHELL OR FRANK SAA POINTING FAINTING POlN'TING REPAIRING WATERPROOFING SIDING GENERAI, CONTRACTOR i 57 BRIDGE STREET Tei. 893-3466 SALEM, N. H. 03074 DATE .. . ..0.5...............20.(�?.V� Proposal and Contraot 000 TO . .. ..�. .... . ... Type of work ....... . . ................................. Arr. ...... ........ PROPERTY ....... .......... rpeza OCA71ON ..... V1e to furni�a necesary IN r, mater.al d equipment (except as noted below) to perform the following work in First Class workmanlike manner. . - Scope of work ZQ't . C4,-... ...... . .. ,d'.�.aG .......+�.P.. ,,,f� .... . ... Z 00 For the Sum of ..... ............................... � • Signed By ...Z ?i.. J ....................... all Commonwealth of M=achuseft �r. Delra�"t of-Industrial Accide,,,, ;wIN600 Tdlashiri nn Street Boston, MA 02111 t �r Workers' Compensation Insur2nce14 ffid$vi But'Triers/C nzas.�govltfia , A licant Information ontractors/Dectrici$ftw?1 zmbers Please Print Leaibl (&�tsincss/DrPnizafionAndividtWy Address: City/std/Zip: Phone#: . Are you an employer?Cheek.the appropriste hoz: - i:❑ I,lima employer with 4. ❑ I am a r o at general contractor and I Type of Prpje ( �[ui : employees(full and/orpart_time]tim,].* have Ind the sub 6• ❑'New construction . 2.�I am.asole" Proprietor or ship and have no employees �' � on the attach:d sheet 3 7. ❑.Remodeling working fbr mein —su&cont�ts have ffiry capacity. workers' comp.insutarfce. 8' Q I�ntilifion [No workers'comp,iastaatsce . S. ❑ We arc a coipora#ion and its 9• ElBui'Iding addition 3.❑ required.) ofn"c= have exercised fheir i dirt n homeowner cloatg all work right0.0 Electrical repand or additions Myself[No-work=' of exemption per MGL 11.❑Piumbi instaarrc,•. 12.0 t gyp' r 1$2, §1(4),'and-we have no TePairs or additions I .•emPloy�s.[No workamu Roof repairs �P• insusan=rcquire&j 13•❑.Other ` 5 appiicattt that checks boz#l mast also fm out th=section below nb� t Homeownem who submit this of&,it indicating they stz �j B theirworkm#'aompenestion Poiicy infcmuiti"L _ ;Cantraemn that check flus hoz raastat�o( an sddifiaas]shee-gs}ww -and ffun hce oatsit}e oontreetors must sabmtt a new affidavit isdi inz U.mm�a df the��.�• �each' m worionfi' :: Gst e�ioyer tizt77 is.onvvi�t►,o:rnerrF�, -w�'••��fosrnatFan. t►jar �= e �r-�r�t�pt rnsr�raace for�'.enminve�; &elo� ' *x Inmrance Company Name: Poficy#or Self-in& Lie.#: Exphdiort Date; Job Site Ad ims Attach a copry of the workers' eooi City/Statr/gtp' petQsalioa policy decFar'ation Page(showing the Purley number aid e Failure to secu a coverage as required under Section 25A of MGL C. 152 MM lead to the i xp►irnfioa date} fine up to S1,590.00 and/or one-year imprisonmmr as wail as civil penalties in the,form of osition of criminal Of up to$250,00 a pena}ti;s of a- day againstthe vioiathor. Be advised that a e Mp WORK ORDER me a fine Investigations of the DIA for ins opy of this statement may be forwarded to the Office of ta'atsce coverage venin""cation. I do he f}' an eP aiul o .rPa7wy J*gr the utfnrmation PrnvMLd zb 5i and oorma Dated ` rd Phone 4ffIeiQ1 use onfy. do not write is tfiic area,to he rnntpteted bYCAY or town oicia[ City or Town: Issuing Authority(circle one): Permit/License I. Board ofBeafth LBiielt#ittg fl'Bpartment 3. (L Other City/TGvve Clerk 4. Electrical Inspector S. Plumbing. b inspector Contact Person:: Phone#: Information a. nd In'structions Massachusetts General Laws chapter l 52 regeures all amp 3 oy=to provide workers' compensation fur their employes. Pursuant to this statute,an employee is defined as"..evm-y person in the service of another under any contract of hire, express or iunplied oral ar written." ! I` An employer is defined as"an individual partnership,$side iafiott,corporation or other legal entity,or arty two crmom of th.t%TegBing engaged in a joint enterprise,and includis-agthe legal represent9h,=of a de;== d employer,orthe receiver ortrvstrzo•of an individual,partnership,associatiair or other legal vnity,employing employees.'Howewcthe ownar•of a dwelling house having not more than fhrre apartments and who resides therein, or fire occupant of the dwelling house of another who employs persons to do ma-imtariance,oonsfruction orrepair work on such dwellinghot= or on the grounds or building appurtanaat th=to shall not bezmuse of such muploymerd be d=ned to be an$mployer." MGL chapter 152,§25C(6)1180 stages that"every state as-local licensing a;eney Shan withhold the ismaneeor renewal of a license or permit to operate a business or *e construct bulMitugs in the commonwealth for any appricant who has not produced acceptable evidence oir eompnanee w16 thp.insarance coveragge require&"`• Additionally, MOL chapter 152,§25C(7)states"Neither ti c commonwealth nor any of its political subdivisions shat] enter into any contract for the perfiorn==of public worie un •acceptable evidence of compliaacx with the iR==- requir emettts.of this chapter have been presat1d to-the cattir•acting authority," ' Appbcenia Please,fill out the workers'compensation.affidavit compi-e--tely,by checking the boxes that:apply to your situation and,if necessary,supplysub-conirador(s)name:(4 addrM9Kes):S1id phone nranber(s)along with their certifiers)of insurance. Limitad'Liabiiity Companies(LLC)ar Limited Liability.Partnerships(LLP)with naeanployees othefthan the me nbers or partners,are not regrmrd,to cant'workem ccs on inwww t= Ifan LLC or UP does have employees,a policy is require& Be advised that this a 5d.- vit may be submitted to the Department of Industrial Accidents for confirmation of insurance caverage. Alm•fie sure to sign and-date the affidavit. The affidavit should be returned to the city or town that tine sppiicartion for the per¢or license is being requested,not1he Deparonmu of Industrial Accidents. Should you have any questionsregas-%Hng the law or if you are required to obtain a workers' oompensation policy,please-ca11 the Department at the•nurrtber listed below. Self-insured mp.npanies should enicrthcir self-instaznce'licerrae Durno—" an tfio appropizatc tier. City or Town Officials Please be sure that the affidavit is complete and printed legibly. 7hc D-part meat hasprovided a space at the bottom of the affidavit for yell to fill out in tore•event the Office of Investigations has to contact you regarding$re appPcant. Please be sum to fill in the pmmitAicense number which w-i'II be used as a reference number. In addition,an applicant that must submit multiple permiWHcense applicatians in any given year,need only submit one affidavit indicatingcurrent policy`iriformafion(if necessary)and under"Job Site Addr-ess"t6 appii=nt should write"all locations in (city or town)."Aappy af'fhe affidavit that has be=.officisily stamped or marked by flu city or town may be provided to the appii=rt as proof that a valid affidavit is on file for futon-e I permits or licenses. A new affidavit must be Ord out each year. Where a home owner or citizen is obtaining a li=Me: ar permit not ralaird to any business or commercial venture (i.e. a dog license or permit to bum leaves ex.)said person is NOT.required to compiem this affidaviL The Office of Investigations would dike to thank you in advance for your coopcsadon and should you have any questions, please do not,hesitate to give us a call The Department's address,telephone and fax number, The Commonwmadth of Massachusetts DcpaT1mcnt of Fmd=b3al Accidents office of Investions 600 Wadh. a�iington Stt=t Boston, 1vIA 02111 Tel#617-7274900 i=4.06 or 1-977-MASSAFE Fax:9 617-727-774: 1L vised 5-Z6-QS VMvW maSS_govidia F N0RTH . 0 of over No. 1:7 1, * _ _ o - dover, Mass., �- COCMICMEWICN ORATED `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ��,�� /,.. ' .............................:. ............. .;>.� �'•.a'`�'°�'.............. .... .a �....... ......................... Foundation has permission to erect.................. g ...... Rough ..................... buildings on ....... to be occupied as......... ✓ ./. :.. ....;7 ........ �� .: ..�.,. ' .� Chimney provided that the person acceptiffg this permit shall in�ery respect c orm 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 ELECTRICAL INSPECTOR UNLESS CONSTRUC ARTS Rough ........... .............. ................ ..... ..... .,�-N-------- Service . .. ... .... .... .. BUILDING 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. ACOR& CERTIFICATE 4F LIABILITY INSURANCE 4DATE/15M2OO PRODUCER (603)898-7000 FAX: (603)898-7070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI( Insurance Express.Com, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND I 284 North Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NH 03079 INSURERS AFFORDING COVERAGE NAIC# INSURED fNSURERA Western World Mitchell Saab INSURER B: 57B Bridge St. INSURER C: INSURER D: Salem NH 0.3079 INSURER E: OVERAGFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER' THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLI( REGATE LIMITS-SHOWN MAY HAVE BE 4 REDUCED BY PAID CLAIMS, INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDfYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDxcurrencel $ A CLAIMS MADE 17 OCCUR NPP1096380 4/14/2009 4/14/2010 M DEXP(Any one arson $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 600, GEN'LA GGREGATE LIMIT APPLIES PER: $ X POLICY E PRO JECT 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: G $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION WORKERS COMPENSATION AND T RY LIA U-TS OTH- EMPLOYERS'LIABILITY FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE$ If yes,describe under PROVISIONSE IAL below F.DI S -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSfLOCATIONSNEMICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO M! 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,B FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON T i INSURER ITS AGENTS OR REPRESENTATIVES.— AUT EPRES TIVES.AUT 10 IZEO=SEEUA 14 h ACORD 25(2001/06) ACORD CORPORATION 1 INS025(mos).oaa Page T----- - . 6L0£0 HN TOWS aoteals!u!wpv ;~ 1S 3Jame L9 ' �ff� a ` 9yyS ll3HD1IW 21O.LO` 'dlN �I l3N3J 8�1`dS ll3HD11W kdsa adl(1�� i`Cy ' 698992 #11 OlOZ14-1uoi;eldx3 66£69 6%•uo! jislBaa lvl l o.LC)"1NOD 1N3W3i1O2ldWl oW0 g spaepuelS Pue s°°!lelnSa�� \_Z5 , etN Massachusetts- Dep1trtment of Public Su ltrds y Board of Builtlino Regulations and Standar Construction Supervisor License License: CS 20864 Restricted to: 00 MITCHELL L SAAB. " 57 BRIDGE STS SALEM, NH 0319 -- Expiration: 7/23/2011 Tr#: 1037 (ummissiuncr ' t - Board of Buildi g Re o°.u✓d a.d. d, Construction 5 f Supervisor License T Lcense• CS 20848 Expie �on x/2/2010 Tr# 15624 Restriction FRANK 57 BRIDGE ! SALEki, NH 03079 Commissioner Location No. Z v Date f;z- 0 O: NCRTN TOWN OF NORTH ANrf O ER 0 R + : Certificate of Occupancy $ C14 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2-Z 2 2 6 Q Building Inspector