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HomeMy WebLinkAboutBuilding Permit #379-15 - 535 CHICKERING ROAD 10/21/2015 BUILDING PERMIT No pTH qti `S' O TOWN OF NORTH ANDOVER O - APPLICATION FOR PLAN EXAMINATION OF Permit NoZI Date ReceivedCH�15Date Issued: Ej�� MPORTANT: Applicant must complete all items on this page LOCATION 'J 3 5 C-e)i C�cr%r) ('Iy-)A—XY it A A Print 1 PROPERTY OWNER "tCAAe-'-i lt—C, • I� -JV rint 100 Year Structure yesno MAP PARCEL:3—`� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family 0 Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ' re.tac�,,� �odcr� dc�moce, -�n Gea\�ca,• Identification- Please Type or Print Clearly OWNER: Name: Phone: f Address: Contractor Name:t0;11;c,,mL.H.CI,cMPhone: 9"T$-301- (-g 4o3 i Address:gglo, .�-Monq • Unli- 104 A+ndovcr , .,114A 01810 Supervisor's Construction License:C-S- Qkpl$q Exp. Date: Home Improvement License: Exp. Date: 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: $ FEE: $ <�j Check No.: 12-CS Receipt No.: 0AQ1& 2— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Aggnt/Owner V Signature of contracto LocationCA e-1411- - No. '' Date . - TOWN OF NORTH ANDOVER 16 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check# S) 2 8 162 61 Building Inspector i 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature M 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS _..... ..... . I 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� p 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) II ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 o 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/Cross Section/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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o 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 2014 NO RTI-� Town o . � : I. , ndover O - 0 No. h ver, Mass, COC NICNIWKw aV� U BOARD OF HEALTH Food/Kitchen PERM D Septic System THIS CERTIFIES THAT ....I" ...... ,,..., BUILDING INSPECTOR ..................... ...................... ............... .......... ..... has permission to erect . ... buildings on ...61�, �. .. Foundation ............ .... ...... .. ...... ... .......... .. ... . . .. ... .. Rough 4 tobe occupied as .... ...... .. ....... . ......... :�!�. . .............r�..I ............. Chimney provided that the person acce ing this permit shall in every respect con rm 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 PERMIT EXPIRES IN 6 MON H ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST S Rough Service ................ . ...... ...... ........... ................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz 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. AHe CQm�onvealtA oftfassugehusef s , Boston,HA 02111 t� .�nu�s .g� fcxr �� ca� ooaou PXasei� 3�xv Nama(Susinesd0zga9zationlP MIduat}:�!1��cl m. t"`Ckkc)L\/ Ad&ass:q '?I) Cit ` oJ�.9' � Ot8 Id Phonull .Are txau exwployex?check meappropriate Yoox: Typo of projectcregmlred.) 1. am.a employer vatb.,A_ y 4• [x am a general contractor ands €i. f]'New edidructioA employees@anandloxpa�fta)T have l�itedtTiesubidkat�s ,7. RemodeEng 2.� 1 am ss�le pxo�rietor or part�aex- listed on to attac�.od sheef- s�.ip and`�avena.emplayees These sat-contraetoxsh�ave 8. �{Demolitlott woxl3ng forme in any capacity. Wa ars comp.insurance, g, Suizding addition PTO wor7�exs'com xnsuxanae 5. ❑�'e axe a corpora�zox�attd its .1Q. Fstectricalxe airs ox addi.�zons P. officers have exerelse(Itheix p xecgized.] 11; J'lumbingxe airs or actMons 3.� X am a honzeowxtex doing alt woxlt right of exemption per�G`& � p myseL[90worlllexs'comp. 0.152,§1(4),andwehavela 1 ,�(?aofxelrais insuxazlc�reczixe .�i employees.[To waxkers' 13.V�©tliez � comp.insnxaneexectuixed �,Anyapplicani.�ai checl�box�lmusEalsa�Tlnnitbesaetionbeldwahowingfheirwbrkers'compensafionpolicy%nfozmation. ,� . x az i Homeownerst�ha submif�afftdavztmdxcai%ngi(�ey�'te dpingalZ�rozkandtbenbire ou�side confraetors mv�sul�m�anewafudapitindicaQngsizc&. xConiracforsiba�cheekfifiis bo�mpstatfached auad�tiona�s�ieetsho�zugthename o�the sub:eonfraefors andthei�vlorkers'eomp.�olicyinfomlauoz�. an exnwfovr tram%provalyg wo.deY�'cornpe asatiort insr��artcefoxYny ern lopee�. Below strte olacy re�cljo x,�it`e ire,formatiaxx. _ -b.SuxaUGe COMPanpName; Y`O�yt-�C�S St�G�t ftp SY15 Rolicy ins orel .Vic.#€: E u sa�a3�5 yir�tlon Date: 5�3 o'�n 1 So1a.9ite.Address:53e �d CityfStatelZip:1�oath P ares -OIQ� Afta.eh,a copy oMe-wogera,compenaataoxe-poRcy dedaxataoxx page(show9nOhe poRcy ximnber and e3Tkatzo;date. liailute to secure:covexage as xeq=od.under Section25A of MOL 0.152 can,leadfo the 1MR0 itian.of eriminaltienaltzes Of e to$1,5Q 0.00 and/or one-year x7npriso vents as wed as czPitpenaltcies in la foxre of'a STOP�N ORZ ORDER,and a fine ofup to$250.0U a day againsttfie violator: De advised that a copyofft statem,en-tmaybe foxwardedto the Office 0 )hVes9gations o1:theDIA fox&Wxance coYexage-VeJ OR6032. IT do Xtex'eby eag, ficlertlie ' ' �er2czrtie�ofpar r'r y trod trte ire,fomita©.n vrovidd ab ova fs fte antieorred,, atare� Thone# G'1 3bI- ut03 og-ela,use 0.rtly. Do noiV1i10 in fibs area,to be coyqletetl by city or tom of YeAd Cat'or Town: �'ex�nztlDicense# ssdag.Antlroxaty(circle oxte): x.�oaxcl 01 wealth 2.Buzzttz�agDepax est .Cayl7mowa Clergy .Rleetxzcatpns ee or �. Zwxt�%ngzns ecto 0 DATE(MM/DD/YYYY) AC40R O_ CERTIFICATE OF LIABILITY INSURANCE9/16/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 CONTACT NAME: Lisa London MTM Insurance Associates PHO AIC NE (978)681-5700 FAJC,AX No,:(978)681-5777 1320 Osgood Street EMAIL .certificates@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURER A-Travelers Casualty Ins Co of 19046 INSURED INSURER B:Travelers Indemnity Com an of 25682 William McKay Construction Management LLC INSURERC: 4 Powder Mill Sq. INSURER D: Suite 101 INSURER E Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 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. INSR ADL R POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IDD DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU-- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE 7 OCCUR 6802D8995351442 /31/2014 /31/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY F1 PRO LOCBINED $ AUTOMOBILE LIABILITY COa accidentSINGLE LIMB 11000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED 6802D8995351442 /31/2014 /31/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE a NIA A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? IEUB2D93637514 /31/2014 /31/2015 E.L.DISEASE-EA EMPLOYE $ 100. 000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below. RE: Lot 4 33 Peachtree Lane North Andover MA 01845 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. Rea Street Development 231 Sutton Street AUTHORIZED REPRESENTATIVE Suite 1B North Andover, MA 01845 M Laorenza/STEPH ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Unrestricted -Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet (991m3)of Construction Supervisor enclosed space. License: CS-046789 s WILLIAM L MCI�AY{ 4 5 KATHY DR T HAVERHILL MA 01832 Failure to'possess a current edition of the Massachusetts. Expiration State Building Code is cause for revocation of this license. Commissioner 08/29/2015 For OPS Licensing information visit: www.Mass.Gov/OPS