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HomeMy WebLinkAboutBuilding Permit #25 - 50 UNION STREET 7/13/2007 BUILDING PERMIT ot"°DT a�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ° � Permit N0:CDate Received �SSACHUS�� Date Issued: —0 �- IMPORTANT: Applicant must complete all items on this page LOCATION - $ � Print PROPERTY OWNER 1- -fie.. r�✓ Print I MAP NO: 3_PARCEL ZONING DISTRICT: HISTORIC DISTRICT yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: y ❑ Commercial VRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic [Sewer ❑ Flood Iain ❑Wetlands fl Watershed District DESCRIPTION OF WORK TO BE PREFORMED: Identification lease Type or Print Clearly) OWNER: Name: F_,A-z- Phone: 97 (a F 7 k/ �5 Address: CONTRACTOR Name 1[-^ - - Phone: 71 6 bo r79� Q� Address: 1 ! . -rt. ( r -re Supervisor's Construction License: 02 "2 Exp. Date � w Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (z6 7 S� FEE: $ 9-0 Check No.: ��,o g Receipt No.: 90M NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Ag nt/Owner Signature of contractor f— � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF -U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ h 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site -yes no Located at 124'Main Street ` m Fire Department signatureldate . 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 ................................................................................................................................................................................................................................................................................................................... ............ 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 o Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products Addition Or Decks o Building Permit Application L, Certified Surveyed Plot Plan Li Workers Comp Affidavit L, Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) u Engineering Affidavits for Engineered products New Construction (Single and Two Family) u Building Permit Application Li Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report u Engineering Affidavits for Engineered products 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location Or"9'7 1 7— No. No. 0 Date NQRTp TOWN OF NORTH ANDOVER F A Certificate of Occupancy $ �',s'••"•'�� Building/Frame Permit Fee $ s�CK Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector °f NO OTM TOWN OF NORTH ANDOVER ' OFFICE OF *.'.°o BUILDING DEPARTMENT « + Building 0 2-36 1600 Osgood Street ulldwg 2 , Suite North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please pM DATE: "7 - 3 JOBL0 CATION: - 6 w S ✓�' — Z 3 Number Street Address Map/Lot HOMEOWNER 1`�- - �" 4 . 9 7 !�8 7 Fr l � 9 7 F y3 Name Home Phone Work Phone PRESENT MAILING ADDRESS l/ 5 /ZW v/ Kq3, City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code*tion 108.3.5.1) DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which hetshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,riles and regulations. The undersigned"homeowner"certifies that hetshe understands the Town of North Andover Building Degartment minimum inspection procedures and requirements and that he/she mply with said procedures and requirements. ' � HO WNERS SIGNATURE S /G� MEO w APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homwwws Exemption BOARD OF WHAI.S 688-9541 CONSERV.IT[ON 688-9530 I1E.u.'f1;688-9540 PL.IVNING 688 9535 .NORTH Town of And AL . .... _ o dover, Mass., T QLAKE COC MICMEWICK �AoR4TE0 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ���.,^- I BUILDING INSPECTOR THIS CERTIFIES THAT.......l...C. 4.. t— . ''` ./... ......r.................................................................................. �•• •••••••••••••••• L Foundation has permission to erect.................................... .. buildings on ...Jr ."..'t,.?.R............0 D. ......r,�............... Rough tobe occupied as.....4 ..........'.�...............�"V . .................................................................................................. Chimney provided that the person acc pting this permit shall in ev ry 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 9-0 am-- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRU T Rough ........................ ....... ......................................................... .... .. Service BUILDING INSPECT 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. .J07f% 1:anz-rrun+aea�� ��,:��i.�G�trtatt��� Vis= BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069242 Birthdate: 05/13/1964 Expires: 05/13/2008 Tr.no: 21117 Restricted: 00 FRANK R STEWART 115 BLUERIDGE RD N ANDOVER, MA 01845 Commissioner Page# of pages INN Thom-is Rich Exterior improvment i 978/490/7479 bTl;ichimProvment@verizon.net Proposal Submitted To: , Job NameJob# Address Job Location / /V � ala V C ! _ �`✓ ���� Date � j � 7 Date of Plans s Phone# - _ � /5 i/G 7 Fax# G_/ �,r�� c �'` Architect We hereby submit specifications and estimates for: ✓ .or. ✓cam 30 / 4/c �.. /CLM_D✓ _ / 1Lrfy _©iS1'OSC ()/� _ 'J��ST.�✓ SN /c, loom - r4C3 ,. ✓ �J✓S e— ...... ......... ru<.v,s^/1/wS7A// Ti-< Aq/lat- .y - /�.. 6, v_iAeA e .�c<�t�Ait Slue%fir ,3iT W, / A.J S _. . L3; 3 J lL I-C/T Ti`Il�lr O�✓ 6A��t�lc Ol'/ Qr /�CG_1�� �i W�Tc--_D/t� �'d t_�C''ft/lrs � �A✓tS _ _ e+ve;rIA71-o-vs... . s ver, rck 5A-/' 7-0 ?Ik Cala.) /114, /0 4/5e 3)�ea Jv S/re 04,'1Y s��'�1aS WAiI' .yi�c_r/ _(j j�c �tAn/�/'AcTv/tr 19 !'e/ioU of '70 Tv.� tA'i e'i,a r,1�A�ro✓C�►r.vi G v r�.v:C ccJ �✓o,�lrs�,y.✓5� ;oar/. 12 � kC�vS/o�vS� /-,p,�.dS ;�viic�d 6,/a�l.�(�.�J�rr'r�co.•% 1✓c'Aj�i I�</.��rS. ���.,�.+�y pi" .t7asT s )2Al;/C/tS /.v A/71C Uf� Sz12r.N6j 7proposeherebyto furnish material and labor—co/mplete in accordance with the aboveespecifications for the sum of: I/Ur/Sft✓ �/ S� .� t4/Y�lCC) 5C vti % vG �/o�i��S Dollars r with payments to be made as follows: �3 Uo�� �3 h �3 Any alteration or deviation from above specifications involving extra costs will be Respectfully �i/ executed only upon written order, and will become an extra charge over and submitted �'� above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within ��. __ __days. 0cceptance of Propont bove prices,specifications and conditions are satisfactory and are Signature cepted.You are authorized to do the work as specified. e made as outlined above. Signature ACORDw CERTIFICATE OF LIABILITY INSURANCE I DATE(%WDDNY'i^rI OV250071 'PRODUCCR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonaldPa.rigione li,sura:ice AgencInc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE & y. HOLDER. THIS CERTIFrATE DOES NOT AMEND, EXTEND OR 0. eox4'8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 1,04 Main Street North Andover, W'4 01845 INSURERS AFFORDING COVERAGE NAIC N Frank Stevmrt 4 PREFERREC MUTUAL ltJSURA C_ t 115 BlueOdge Road ;43;PER. THE HARTFORD GROUP No Andover, NIA 01845 ONE BEACON !NSURANCE -4 COVERAGES THE POLICIES OF INSURANCE L:STED BELOW HAVE BEEN I SSUEC TO THE INSURED 14AAIED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF AN'CONTRACT CP OTHER DOCUMENT WITH RESPECT TO'JWICH THIS CERTIFICATE WAY BE!SSUED OR MAY PER TAM,THE INSURAJVCEFFORDED 87 THE POLICIES CESCR)BED HEREIN IS SJBJECT TO ALL THE TERMS,EXCLUSIONS AND CnNDIT:0N5 OF SUCH POLiCIES,AGGREGATE LIMITS Q'HOYVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FE0C EXP:RA'rCN I-N;R ADD'L— —I POLICY INS r POLICY NUMBER PC WE T LIMIT$ iYPE OF INSURANCE D DATE L LIABILITY 1 s A C'P P 0 110 5 3 4S 7 6 l2k2j"21006 12/02,2007 E,v 1,00c,00c I LL: I 10u 000 'LAIMSt-ACE L��j:Kcj�l 5,00C PERKIALJ PbV NR iF'� I T 1,000,00c GENERAL A(zi-IPEGA*Tm 5 33.006 000 1 C F -SA TE L PAJ T A PP L E F 3,0DO,OOC X: C AUTOMOBILE LM IJTY E 0 55)5 45 04,'l'i2006 D4/11/2007 kil f iEe ac.wem- 1,LL OVPIED AL;T '-,CHECL-Ir 1,00o,000 i 2i AUTO NON-(YANED I�U'.,Ql; 1,000.000 PROPERTr Clil',;AGE 200,000 GARAGE LIABILITY 4111-11113-JLY-EA ACCIDEN. ALIIO EA$k--- S if�C WL �EXCESSAJWERELLA LABILrr-( E a,CH )--:JR.RENCE C LA.Y z WhL-E 4GGREC-ATE -'EL)UC75LE PE9T170',' B WORXERS COMPENSATION AND 08 VVECRH21342 36/091'2006 06/091200 ITCRYUVr -Er EMPLO.ERS'LABIL17Y E EACH.A,--ClrEN7 S 500.000 E L DISEA SE-U E,'-IPL(jYE-z 5 if, 5001000 :A C:;DvrC'4-2b,3'c,.q El_DISE�SF-F'nICYUtdr I OrHCR DESCRIPTION OF OPERATIONS I Lor4TioNS11 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SnC;AL PROVISIONS iJcbSite: Renovatio!i!3G,8-"ICOMerbiehea,--iSt., NoA,�,,dover. MA,01345' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE C-ESCRIBEC POLICIES BE CANCELLED BEFORE THE EXPIRATION Tow of North Andover DATE THERECF.TliE ISSWNG PNSU RR WILL ENDEA,(DR TO MAIL IC WAlb WRITTEN Building Department NCTICE TO THE CERTIFICATE MOLDER NAWE0 TO THE LEFT,BUT KLURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY CF ANY NPID UPON—HE INSURER, AGENTS CR North Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 0 ACORD CORPORATION 1888