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HomeMy WebLinkAboutBuilding Permit #373-13 - 57 GREEN HILL AVENUE 10/21/2013 c y �f N�aoT aq,Vo E' BUILDING PERMIT TOWN OF NORTH ANDOVER 03APPLICATION FOR PLAN EXAMINATIO b Permit NO. Date Received - �4SSACHUS Date Issued: I ANT:Applicant must complete all items on this page LOCATION "41 II Print PROPERTY OWNER.9—/ r o0 `4 ky kl eod..4 le) a2n� Print MAP NO: � PARCEL:DZONING DISTRICT: Historic District yesnno Machine Shop Village yes 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: g Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer M� �dT1��irl� L✓1�//S jrJ 'l S�rcv� I�E..-ar�yG . CJS�°4.i/,st� C.,- I4",e kv- Identification Please Type or Print Clearly) OWNER: Name: u . !1e/,n kl a A) Phone: Address: e-IL,&J 1�' ✓ kot)4.p. 0)? . CONTRACTOR Name: Popne: {: -17-?a-6 Address: J Supervisor's Construction License: 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: $szFEE: $ T 1` Check No.: Receipt No.: NOTE: Pers s contracting with unregistered contractors do not have acc a guaran d Signature of Signature of contract F,w. � � � p� s .. 4ai: . �-.�. l t � � ' ' 1 � � � � .. y - � .. - . - - - � ` w , 1 . • J \ •� ` 1_ .. � ,� ..� �� 1 « I� ' g R t Y�y� _ 4 ' fix. ;t y n l�r.� Location No. —t Date V=3' - I . - TOWN OF NORTH ANDOVER • � Certificate of Occupancy $ - Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit F-ee $ TOTAL 1 Check w;)L3 27021 Building Inspector e TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page TT T r" t* r a f' .w ., 1p- a. % ° f' €., } LOCATIONS _ - x SSPf � 44 aux . x .< 'PR0PERTY�OWNER " - Print 100�Year Old'St cure ye no ^r, MAP O NPARCEL' ZONLNGDISTRICT Histone District yes+ ono ¢ �_, ° � ,��� Machine�ShopVillage dyes _ �nop� 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 -.�.. ..'a _ ,Septics Well, _ ,❑+Flogdplamr ❑Wetlands<' ❑ INatershedDisfnct _ M,Water%Sevv_er� DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: r . - - t 'max =A i CONTRACTOR`+Name <s` _ Phone - ' r� r = - - r - -- , dd Supenlisor's Construction"License x _ Exp ,Home Improvement Licenseh ` ' Ezp 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: $ Check No.: Receipt No.: NOTE: Persons coptNacting with unregistered contractors do not have accetc to the guaranty fund Dinne Ci ihrniffnA i i Pinne \A/nivarl n C'PrtifiPrl Pint Plan n Otamnpd Plans n Building Department The foh,)wing is-a list of the required.forms to be filled out for the appropriate permit to-.be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ . Building Permit Application o Workers Comp Affidavit i ❑ 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 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 . 0 Plans Submitted ❑ PlansWaived ❑ .Certified Plot Plan ❑ Stamped Plans ❑ -TYPE--0E-:SEW-ERAGEDISPDSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ 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 i HEALTH Reviewed on Signature d I COMvMENTS 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 Tow2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMr ItIT =-Temp Dumpster onsite yes no Located at-,12*4sMa'ir Street Fire Departine►it signatureldate ,r '`�;, 5.. ':. ��; -. .e#� ', �•�, .•, �. ;.� C011f1-MENTS I 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.$100-$1000 fine NOTES and DATA— (For department use I �I for pickup ® Notified o ku - Date Doc.Building Permit Revised 2010 3 Massachusetts-Department of Public Safety Board of Building Reguiations.and standards Construction Supen-isor icense: CS 66686 DANIEL,TMSEJLA o POW 26 WINTERG;BEEN Cl€I VEZ METHUEN MA 01844 Commissioner 07/1812015 &Bo�� n4gntanoo lflt 4 a /r lveIrAlvairs OICTO Tie: s° Office of CpII MEQ CC ua► .pME 1MpROVE Z4p16 1 MOR M egis6pn_ 515!2416 (0161� K�nseUa a 11a g U ud tela�l • Dapie► 1Cinse ersec �i►nter9reen Cir - 26p1aAA � Methuen`, lam. T __ r 1 NOR_T. - r c ver 00h ver, Mass o COCHIC Mt WICK J.9 A�RgTEO S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........S.. ........ � f `�� - .... BUILDING INSPECTOR: - L� ,, has permission to erect .......................... buildings on ...���...... ��.......... Foundation Rough to be occupied as ... p a'a:r`.'.'.�:�.�. .1... ........!..... ....!�.1.� ..® 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 PERMIT EXPIRES IN 6�MPNTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STA Rough Service ............. .... ... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit 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 ACGIRV® DATE(MMIDDNYYY) 16.� CERTIFICATE OF LIABILITY INSURANCE 6/17/2013 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 CONTACT y NAME: Trac Loeschen DeAngelis Insurance PHONE (978)682-3397 FAX Nolq (978)681-0773 283 Merrimack Street EMAIL INSURERS AFFORDING COVERAGE NAIC N Methuen MA 01844 INSURERA:National Grange Mutual Ins Co 42 INSURED INSURERB:ZuriCh Insurance Co. Kinsella Construction LLC INSURERC: 26 Wintergreen Circle INSURER D: INSURER E Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 term 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEIm JIM POLICY NUMBER IMMIDDfYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA E O ENT X COMMERCIAL GENERAL LIABILITY PREMISES Ea oc urrence $ 50,000 A CLAIMS-MADE a OCCUR MPB28029 11/26/2012 11/26/2013 MED EXP(Any one person $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 [GE�'[_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 7 PEC�RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accid nt A ANY AUTO BODILY INJURY(Per person) $ 250,000 ALL OWNED X SCHEDULED 9M24469 9/26/2013 9/2 6/2 014 BODILY INJURY(Per accident) $ AUTOS AUTOS 500,000 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE P r dem $ AUTOS Underinsured motorist BI split $ 250,000 UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION WC STATU- I JOTH- AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUI— E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 6ZZUB056ON816 5/29/2013 5/29/2014 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate is issued in the interest of the named insured and holder listed below. Subject to company conditions and exclusions. Dan Kinsella excluded from Workers Compensation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE David Segal/NNM ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Kinsella Construction LLC Invoice 26 Wintergreen Circle Methuen,MA 01 844 DATE INVOICE# Cell 978-857-7320 9/24/2013 558 Fax: 978-557-5490 NAME/ADDRESS Ship To Steve&Kim Kochaldan 57 Green Hill Ave. N.Andover,Ma 01845 Description TOTAL . bemo-Remove"-sheetrock&stud walls from basement. 2,800.00 Remove suspended ceiling. Remove carpet from 3 season room. Remove heating cabinet from basement Dispose of all debris in proper Facility Thank yo for your business! Total .$2,800.00 Payments/Credits $0.00 Balance Due $2,800.00 1