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HomeMy WebLinkAboutBuilding Permit #596-12 - 50 PILGRIM STREET 2/8/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � r �^ Date Received Date Issued• ` -k. ��- EWPORTANT:Applicant must complete all items on this page LOCATION -, ('f" ,? 4R i em S Print PROPERTY OWNER r�R 1�dy/Le2 Unit# Print F MAP NO:�_PARCEI ,� ZONINGDISTRICT: Historic District yes Machine Shop Villageye 100 year-old structure ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 0 Addition ❑Two or more family ❑ Industrial N Alteration No. of units: 0 Commercial . 0 Repair, replacement ❑Assessory Bldg 0 Others: 0 Demolition ❑Other se tic '®Well , ti "fit `{3j®FljF ood7�'lain" 0 Wetly ands '[' Oj,[[Wates e"dDistnct r...r..p ...I' ,'?+rr" ec,. 3its•� qt "®_.rL u, l" kw"•f` 4 a� "". ""aa ,rb,'.ai S'+ - Water/Sewers Y rt- •^� ', ^c 1. s:....-s-+myr.' iSr. DESCRIPTION OF WORK TO BE PERFORMED: le� (Identification Please Type or Print Clearly) OWNER: Name: A e Phone: ' Address: J �e CONTRACTOR Name: Phone: �.2 — X635 Address: � /17j4 Supervisor's Construction License: ,5-7y Exp. Date: 07 — o2 ? /2 Home Improvement License: 3 9.2 Exp. Date: 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: $_ ,��� FEE: $ � :2 Check No.: 016 Receipt No.: 1=7 NOTE: Persons c refracting with unregistered contractors do not have access to the g unci R 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 o 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 o Workers Comp Affidavit ❑ Photo Copy of H.1.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) ol 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 N OTE: 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 in lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi 1 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 i i CONSERVATION Reviewed on Signature i COMMENTS HEATH Reviewed on Siqnature 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 I FIRE DEPARTMENT -Temp Dumpster on site yes no j 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.: I 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.$10041000 fine i, NOTES and DATA— For department use F LJ i Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location, No. Date�•-� e - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ t " " Other Permit Fee $ ? xrn .y TOTAL $ Check#-41- 6( 25019 Building Inspectors NORTfy Town of 0 .. No. o , dower, 1Vlass.,a • % • ,tc)� LAKE COCMICHEWICK DRATE D p' -`C U BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......................... ......................................... ....... ............................... ................ Foundation has permission to erect..... ..................... buildings on ......... ....0 . . • .............. _ ........ .... .r N..�....... .. .............. Rough _ to be occupied as........... .. ......... .......... ... r......... 0. .�. Chimney ........ ...................... provided that the person accepting this perm shall 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 ELECTRICAL INSPECTOR UNLESS CONSTRUC T Rough - .........................................................._......... . ... Service BUILDING IN PEC R 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. ADD-IT-NOW DORMER CO., INC. TOM LEONARD, wne 6 Allen Road Ext. 532-1635 Peabody, MA 01960 DORMERS * ADDITIONS * SECOND LEVELS PROPOSAL DATE NAME v e-- eSTREET ,o;C� �: 1Z .: CITY 42State_ Zip o b PHONE _ 3J 1. Size of Dormer—Second Level—Addition I 2. Excavation and Foundation if any 3. Framing and Sheating _ 4. Windows j6 "�LA7 1 eje3/�r�`l 7�.'%c'�j/eic a;ol ,}+ ` /27//2 �e'r-e "f Cl /�/fJ Cl/�� :Sl 6 3 4A Doors 5. Roofing Color 6. Siding �/t ei- / YL 4r,'/.ek!C Corners 7. Gutters and Down Spouts 8. Inside Framing " f - vee 9. Insulation 10. Heating �- 11. Plumbing — 12. Wiring 13. Exterior Finish e 14. Interior Finish '/`73�,t' - l/tt e . Z`&gri- 15. Floors 16. Extra Items c c �. s-• ZZ r t 17. Clean Up Complete Price S 3 Payment to be mad_q- follows: / � ` S / DATE OWNER REPRESENTATIVE OWNER ALL WORK AND MATERIALS GUARANTEED"3 YEARS. 1 Q}r DATE(MMIDDIYYYY) A�V CERTIFICATE OF LIABILITY INSURANCE 1/27/2012 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 NAME. Lori A Cote EA Stevens Company, Inc. PHONE (781)322-2324 FAX No):(781)397-7672 389 Main St. EMAIL _loric@eastevensins.com P. 0. BOX 188 - INSURERS AFFORDING COVERAGE NAIC# Malden MA 02148 INSURERA:All America 0222 INSURED INSURER B:Central Mutual 20230 DBA ADD IT NOW DORMER CO INSURER C: 45 GARDEN ST INSURER D: INSURER E: WEST NEWBURY MA 01985 INSURER F: COVERAGES CERTIFICATE NUMBEROASTER 11-12, 12-13 (WC) 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. INSRTYPE OF INSURANCE AD B POLICY NUMBER MMfDDIIYYYY FF POLICY WD Y EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 }� COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE F0 OCCUR CLP 7923868 /22/2011 /22/2012 MED EXP(Anyoneperson) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 T POLICY PRO-lFrT F-1 LOC $ C AUTOMOBILE LIABILITY a acciden SINGLE UMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS- NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLALIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC STATU- ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/E)(rCUTIVE Y= NIA E.L.EACH ACCIDENT , $ 100,000 (Mandatory In NH)OFFICERIMEMBER EXCLUDED? 795974016 /31/2012 /31/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Add It Now Dormer Company Thomas Leonard 45 Garden St AUTHORIZED REPRESENTATIVE West Newbury, MA 01985 i Thomas Peter Cares Jr, CIC ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn95 rmtnnm m Th.ACnon .nA 1---o n—1.+-4—stirs_f At'non ta '..F 9b9S L7smsbsissss�i �, tie'�r{ ( . +,'. Z l0i*/£ !L rtoendX3 -';;." ' 986.10 t1W'X6n8M3N 1S3M. . ' iS 1\1306 E)9tr 00 :0;p0101.4 saa 1 '" 808LS sb :asuaarj asuaoi aosOuadra not anJ sua `j .. l 5 3 �. O , .� '(lat�pu Pttr su�rlt I1t a oEttpttn.g,jo 0:prt}g a s€ 4 3ttt#td 10 20ttMI F Office of Consumer Affairs and Ilusiness Regulation 10 Park Plaza -,Suite 5170 Boston, Massachusetts 02116 Home Improvement C.ontr ctor Registration ~� Registration: 108392 Type: Individual Expiration: 8/18/2012 Tr# 202356 THOMAS A. LEONARD Thomas Leonard 45 GARDEN ST WEST NEWBURY, MA 01985 ' ' Update Address and return card.Mark reason for change. i DPS-CAI 0 50M-04/04-G101216 Address Ej Renewal E] Employment Lost Card 1 ✓�ie -t°io�nvnauuea/,t o�,,/�aaaac�ivaeft6 Office of Consumer Affairs&B siuess Regulation License:or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 0108392 Type: Office 4 Consumer Affairs and Business Regulation Expiration: 8/_1,812012 Individual 10 Park Plaza-Suite 5170 3= ====a Boston,.MA 02116 T AS A.LEOINARD}.--] Thomas Leonard 45 GARDEN STS . WEST NEWBURY,MA,01985 . 7 Undersecretary Not valid without signature