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Home My WebLink AboutBuilding Permit #452-13 - 51 COCHICHEWICK DRIVE 12/6/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received I Date Issued: IMPORTANT:Applicant must complete all items on this page j LOCATION p:rint r - PROPERTY OWNER-.- T �c-- d ✓ Print 100 Year Old Structure yes no. MAP NO: ARCE ; ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE ' Residential Non- Residential ❑ New Building pne family ❑Addition ❑Two or more family El Industrial i teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District, ❑Water/Sewer. DESCRIPTIO OF WORK TO BE PERFORMED: �� b(� L- ISTl!1c T � r%t TT614 J � l t/�Vr j T �r/ y✓,�LLS . ��.2 /, ! e R L-e Li/ LLS Ol Tb CL' i /l I n/ !'T L1 Ald Identification Please Type or Print Clearly) OWNER: Name:' Phone: Address: ; CONTRACTOR Name: � ' /�L' Phone: 7 / 6Z �G 7 Address:. ZZ 7A Supervisor's Construction Licenser `T � Exp. Date: l��l Home Improvement License: Exp. Dater i ARCHITECT/ENGINEER Phone: ,. Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $y2FEE: $ i Check No.: �3 Receipt No.: ('0 NOTE: Persons contracting with unregistered contractors do not have a cess to the guaranty fungi?, Sig natureofaAgent/0wner Signafure of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ mped Plans 11 Location No. Date TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � m Other Permit Fee $ TOTAL $ r Check J13-7- 26018 Buil ing Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools Tanning/MassageBody Art ❑ 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 Q 5 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towp_Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT _ Temp Dumpster on site yes no Located at 124,Main:Street:. Fire Dep? ,. a t�siggiiature/date COMMENTS I - i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. j I Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes. —No— e esNo DANGER ZONE LITERATURE: Yes No a MGL Chapter 166 Section 21A—F and G min.$10641000 fine j I I NOTES and DATA— (For department use) '. i � I i I ® Notified for pickup - Date Doc.Building Permit Revised 2010 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. f Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C.And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work u. 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 Departmentrior to issuance e 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 j 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 i Doc: Doc.Building permit Revised 2012 i ARBE LLA® INSURANCE GROUP Elaine Dupuis-Lane,Claim Manager 03/19/2015 Town of North Andover Town Hall-Bldg.Inspector No.Andover,MA 01845 Clain Number. 033545817 Policy Number. 63872400004 Company Name: Arbella Mutual Insurance Company Date of Loss: 02/11/2015 Insured: PAUL ROUTHIER Property Location: 51 CO(HCHEWICK DR,NORTH ANDOVER,MA To Whom It May Concern: Claim has been made involving loss, damage,or destruction of the above captioned property, I which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143,Section 6, to be applicable. If any notice under Massachusetts General Law,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer.Kindly include a reference to the captioned insured, location,date of loss and claim number. Very truly yours, Cynthia Holden-Amor Claim Service Specialist Property Claim Office 800-272-3552 ext.7549 Fax 617-773-4760 —Too Crown Colony Drive P.O.Box 699195Quincy,MA 02269-9195 telephone(800)ARBELLA www.arbella.com I h 1 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 303 Date: January 122007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 51 Cochickewick Drive i MAY BE OCCUPIED AS .Attached Town House ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Campion Hall LLC 865 n nj ike Street Nort dover MA 01845 9 Building In pector 1:071 I I I CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 303 Date: January 12, 2007 THIS CERTIFIES THAT j THE BUILDING LOCATED ON 51 Cochickewick Drive MAY BE OCCUPIED AS Attached Town House ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER i REGULATIONS AS MAY APPLY. I i Certificate Issued to: Campion Hall LLC 865 Turnpike Street No Andover MA 01845 Bui mg spector I i i j . I 1 . j To ot Andover- 0 No. V3 as e OL A o f dower Mass. n n D COc.":..WICK V ' ' �d ADRATED P' C 7S G _` 4 BOARD OF HEALTH Food/Kitchen Septic System . PERMIT T DBUILDING INSPECTOR THIS CERTIFIES THAT....... ... m tA..1...... 1 iA. ...................................... �� . .. . wo —twz_e>A� has permission to erect.... r. buildin s on ..... �.:&C� C l�K �� aw . .............................. to be occupied as ��! �! 1 s *0 C&M 044 �i Chimney provided that the person accepting this permit 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 I/SPECTOR . VIOLATION of the Zoning or Building Regulations Voids this Permit. ��1`PERMIT EXPIRES IN 6 MONTHS `' ELECTRICAL INSPECTOR UNLESS CONSTRUCTT N TANTS — .................:..........:....... Service �d BUILDING INSPECTOR Occupancy Permit Required to Ocmt�,7 Building g GAS INSPECTOR gh� �-J ` //Y� .> Display in a Conspicuous Place on the Premises - Do Not Remove F No Lathingor D Wall To Be Done Dry FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. S'/nv C05 W O Too APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # 3 D B - 4-y 30,y 13 i 3 0.4 a 0*0 ADDRESS/LOCATION OF PROPERTY : 51 9 I I Map Parcel Lot Number SUBDIVISION I DATE REQUESTED FILED/READY FOR INSPECTION i i CLOSING DATE ON PROPERTY: i FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED i ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00)WILL BE CHARGED IF THE STRUCTURE i DOES NOT MEET PPLICABLE CODES. i SIGNED I I ROUTING i i i ! vONIS ERVAT.10N i PLANNING DPW -WATER M ETER 6 M E-r IZ_s SEWERMATER CONNECTION NOTE i DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTA OF THE OCCUPANCY/INSPECTION REQUEST f I, DPW �jf1 Signature .. I File: OC farm revised 2006 i I ' I I I r l i 91 C �i yA ' �T,� n4.srsv+hNa,t�c, I S-�AP3�li"a� APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # 30 413 ADDRESS/LOCATION OF PROPERTY : Cc�ltlarlt,,�Gt. R Map Parcel Lot Number i SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET PPLICABLE CODES. u SIGNED ROUTING t1 0 CONSERVATION PLANNING DM-WATER--METE-R 6 m SEWERIWATER CONNECTION NOTE I DPW MUST INDICATE THAT THE WATER METER HAS BEEN WSTALLED PRIOR TO SUBMITTA OF THE OCCUPANCY/INSPECTION REQUEST I DPW Signature File: OC form revised 2005 r NORTH _ -.--- To t _- 6 - n-dover.own O4 �► .yr. No. .� 3 ,-� y 5;t C% LAN! h ver, Mass, • • COC NIC Nl W�CN ��, s U BOARD OF HEALTH TFood/Kitchen PERNLD Septic'System THIS CERTIFIES THAT BUILDING INSPECTOR ....................a4.�,. ........ �. .. .....................r....... . . . ........ ... ... Foundation has permission to erect .......................... buildings on .... .......C"o ......... !...��r.�....... .. V 0Rough to be occupied as ........ .. ... ...... ..... 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 INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 67 PERMIT EXPIRES IN NTHS ELECTRICAL INSPECTOR '" UNLESS CONSTRUC I ST Rough Service .............. .... ......... ...... ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Occupancy 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. SEE .REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations UIP. 600 Washington Street I Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lggibly Name (Business/Organization/Individual): d /�� i7 U/ L� n , �2j� �� J�� N 'f /1 � f� Address: f / L ; _ City/State/Zip: rT �? Phone #:_b'-2� 1 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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. 1 7. VRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. ers' comp.insurance. [No workers' comp,insurance 5. �e are a corporation and its 9. EJ Building addition required.] officers have exercised their 10.[1 Electrical repairs or additions 3.❑ I 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.]f employees. [No workers' comp.insurance required.] 13.❑Other ! Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. tam an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site 'reformation. assurance Company Name: 'olicy#or Self-ins.Lic.#: Expiration Date: ob Site Address:_, - C.GC//—/c � (//C City/State/Zip: kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of svestigations of the DIA for insurance coverage verification. i do hereby certify under the pains and penalties ofperjury that the information provided above is rue and correct. i nature: Date: v hone#: � — 6 I Official use only. Do not write in this area,to be completed by city or town official I City or Town: PermitALicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ` i Department Massachusetts- of Public Safety I Board of Building Regulations and Standards Construction Supervisor CS-025620 License:�,C,f.rs t, ROBERT C BAAFY P.O.BOX 63$ 01845 h N ANDOVE0-MA - v o• �c��a Expiration', Commissioner 03!10/2014 05 ,Vfe Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR gistration: ,,I, 19piration:,_=.41-30)14_j Private Corporatic, ROBERT.C.BAILEY?,PIL-DING`&REMODELING INC ROBERT BAILEY 16TIFFANYLANE METHUEN,M 01844 Undersecretary i I ' 1 I I I ' I J I { F I r �