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HomeMy WebLinkAboutBuilding Permit #433 - 58 MAIN STREET 11/21/2011 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:-83-- Date Received Date Issued: IMPORTANT: Applicant must complete all items on this age LOCATION Print PROPERTY OWN ERh Unit# �/ Prin MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no 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 0 Others: ❑ Demolition ❑ Other Septic ❑ Well ❑Floodplain D Wetlands, D Watershed District 0 Water/Sewer Rem oAt DESCRIPTION OF WORK TO BE PERFORMED- OWNER: entificati n Please Type or Print Clearly) OWNER: Name: �f n® Phone: Address:Tg ft /�'I(�i�l �_�/Y® / �1 CONTRACTOR Name: C, �1S!IVAPt'6iPhone: S_—'5315 Address: .5 A* Supervisor's.Construction License: S Exp. Date: Home Improvement License: _ f 6 f F Y6 Exp. Date: G '`? ARCHITECT/ENGINEER �� � Phone: t 0_-3 * o ? rq Address:_ J �� R ..�_4LI 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: $_ �y, 70FEE: $_ /0� 9DO l0 / Check No.: p Recei t No.: ca NOTE: Persons contracting with unregistered contractors do not have access to the uar n nd I I Sign t qua r of�Agent/0wnera nature of.contractor �r — — J Plans Submitted ElPlans Waived ❑ Certified Plot Plan ElStamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swmunmg 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 HEALTH Reviewed on Signature CQNIMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ILi Planning Board Decision: Comments Conservation Decision: Comments � I 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 1 Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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 i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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 ❑ 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 g g Affldavlts 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 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: Doc.Buildin g Permit Revised 2008mi Location Aw�.� No. 83 Date i MORTh TOWN OF NORTH ANDOVER f ,� O Certificate of Occupancy $ CNUs t� Building/Frame Permit Fee $ lo _ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `" Check #w/b 2 4 8 �J Building Inspector _ �ORTI-p To of 0 No. o : over, Mass., Ilee1�• l l o �. 2COCMICMEWICK V ADRATED P'P�t�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........................................o4. �6.....dommo.........�. .........�. ..... . ........................................ Foundation has permission to ct........................................ buildings on .�.°...(*.((........... C lot...... ....�...... Rough ... to be occupied as ......V ................ . Z .. ! .....UU6 provided that the rson accepting this permit shall in every respect conform to tlfe terms �f 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 CONSTRUCT9--ItL Rough ...... ..... ........ .. Service BUILDING INSPECTOR 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 FIREE_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. IIS _....._._.._..... _.... --•~ 1►8::I1 �rtvr►t c yr L.tKf�tfLt t t ttv�trt�trVC 1 12 2011 TM CEffn RTE IS ISSUED ASA BATTER OF INFORMATION i J .;Gorge Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THS CERTIRcATE DOES HOT AMEND, EXTEND OR 6;';Foster Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P+ abody, Al 01960 978 531-2179 96SURERS AFFORDNG COVERAGE MAIC* AFFORDABLE PRECISION INSURANCE COWANY SHSRAJ. ER INSURERB: 2 BRADFORD STREET INSURER C: SALEM, MA 01970 tea. DISUPIER E :OVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN T uED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATE.NOTWM6TANDING ANY REOUIRI34ENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WftH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.7HE INSURANCE AFFORDED BY THE POLICES DEED HEREIN IS SUBJECT TO ALL.THE TERAS.EXCLUSIONS AND CONDITIONS OF SUCH MAY-KA%S8EENR8XWEDWpADaA*AS-- or ONYU — — - TR N= POLICY NUilem pA Llmr S GENERAL LIABOM ----- -- EAC"OSE S 1.000.000 X COMMERCIALG84ERALLIABUM UANVffiEiOHw#leU De Amm S100 000 CIAMISMADE EJOCCUR NEDEXP +womam►1 S. 5 000 A gig 02/06/ 11 02/06/12 pmsmmaAwww s 1 0 0 000 GENERAL AGATE S 1,000,000 GENS.AGGREGATE LIM�PPI.M PRoatICTs-COMPIOPAGG s 1 QO QQ POUCY LOC AUTOMos"ELw6A1TY ANYAUTO COMBIMMSINGLE- UM S ALLOWNED AUTOS SCHEDULED A ITOS (ftrpwwn) S NRW AUTOS NOM NR*DAUTOS BOOILYINAW S PF40PERW DAMAGE $ GARACELIABRM AUTOONLY-EAACC RT S MYAM EAACC S AUTOONLY: AM S LIABILM EACH OCCURRENM S OCCUR EICLANASMADE AGGREGATE S S DEDUCTIBLE S RETENTION S S � 0 6S601DB-0484L88-5 04/07/11 04/07/ 12 E-I �T - T S 3 F!FX�XAP�N a3�0e ELL DISEASE-FA EW S gag PROWS O 6 bebw ELL D1SEASE-POLICY UM S 01HE R -:SCRIPnONOFOPMTKMILOCA7IONS/YEHICLMIEMUSK NSADDEDBY8mo0RsEmewiSpeMAi.PFMV 'kTTN: Debra Russo i E RTIFICA TE HOLD CANCELLATION Ader Construction SHOMDANYOF'"EABOVED BE CANCELLED BEFORE THE DWIRATION DATE TH8*-OF,THE ISStlWG INSWER WILL 84MVO R TO MAIL DAYS WRITTEN NO71C.E TO THE CEPMFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DD SO SHALL TIONOF ANY XWD UPON INE INSURER ITS AGENTS OR ATNES ATAIE 1 r• . t The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensatio4 Insurance Affidavit: uilders/Contractors[Electricians]Plumbers Applicant Information Please Print Le ibl r � Name(Business/organization/lndividual): Address: 2- rt ADWA City/State/Zip: ''1Q QJ I Jahone#: Are you an employer?Check the appropriate box: Type of project(required): 'I.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. �• Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.n Other *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew•affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insuranceformy employees. Below is the policy and job site information. \ Insurance Company Name: JCe6n VI V00(C ki e 11 Policy#or Self-ins.Lie.#: 0(0 U 13— O� RI C��—J Expiration Date: OV ` � ` PL Job Site Address: 5'94 At in S 7" City/State/Zip. , kodo V17r/ q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby certify d e • and'penaldes ofperjury that the information provided above is true and correct. _ �' G D Si ature: / Date. Phone#: F cial use only. Do not write in this areato be completed by city or town official or Town: Permit/License# ng Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 4: Robert R Bussier�P.E. November 7,2011 342 Candia Road Manchester N.H. 03109 Cell 603-860-2639 Fax 603-627-1456 Email Roribus8@a,gmail.com To: Gerald Brown CEO Building Dept 1600 Al Osgood Street North Andover Ma, 01845 Re: 58-64 Main St North Andover Ma Alterations and Renovations The undersigned examined the structural aspects on or about October 19",,2011. This work included structural repairs, generally at the bathroom floors and some ceiling joists and roof rafter repairs. Also included was fire blocking at the floors and ceiling,plus insulation,type x gypsym boards, and new windows. All of the above was performed in accordance to the Commonwealth of Massachusetts building code and the plans submitted to the North Andover Building Department. Respectfully, et} i RI v Robert R Bussiere P.E. op SOLD TO: `C� OL SHIPPED TO ADDRESS: J ADDRESS CITY: STATE ZIP CITY STATE ZIP °Ci�s�'�a��'�zb�S��R•� �'`�x '�f�"L�SPE�S©N ��.,i�^�'` `�TfRIv�$� � "�*,` �4A�'' � ° ���. ' �O g�" Y y �` `` L)}�,�'�E��s.�� ���Wv�,�`',`. � o-'�a`r'' p`' xw C�"4•�`a�,LdY- �d'kt'6 'auk.±v 2 ,k�',ly.,�y�: �'G"'t -y�, ,�.� �aax# � � J as;,,�„�,6 ", " _- t r F��/] u� M -� k �.,,�.r�-k.>° � t L�.• :X 7 � d - tam ,,,,,rd's,,,.,a ,�y - �� „�'� �"/�/��,�..�/�" �^t. 4. �I+f 'IVF'/ I i 1`'•i"e! s 1 R 1 ` e 0,11W7 42.4ZC--- t 1 fM1 .yrs% 1 t 1 f 1 w i 1 ij/] ry 1 s 1 / � , 1 y}1 t 1 1 1 1 i 1 / F • v f 1 I 1 � 1 6 1 1 1 1 1 ! 1 1 1 i ! 1 i I 1 1 P f . 1 1 1 1 I i T 1 ! 1 1 1 1 e 1 1 1 t i t 1 1 I I 1 1 ! 1 D8140 INVOICE I Oflice�t�on� ��c HOME IMPROVEMENT CONT mess eg—u7a�Pb License or registration valid for individul use only _ Registration: ACTOR before the expiration date. Expiration: '469246 Type: If found return to: 02/2013 Office of Consumer Affairs and Business Regulation A Q Individual 10 Park Plaza ANDER SHERAi _ Suite 5170 Boston,MA 02116 ALEKSANDER SHERAJ';;, 2 BRADFORD ST. SALEM, MA 01970 Undersecretary l(� ii No-valid- --- sig'wure �1 .issachusetts- Department I tnt of Public Safietv Board of Building Regul.ttions.ind.Standartls Construction Supervisor License License: Cs 103517 Restricted to: 00 ALEKSANDER SHERAJ 2 BRADFORD ST SALEM, MA 01970 Expiration: 7/22/2013 ('e>mnrissiuncr ; Tr#: 103517 ----f- i���•�� , � � I .. ; � ' , � � + I - � ". I I ! i I I � I I i L;-, �` -- i-" I I I. :��'°+ �i�,�w --- ± I i ; - I 1 ; � I �� I , I I I I � I , � ; � I I � �� � I r— I � _ I •".r,,�, I { -- I I 1 I -.I � � -{ �_ j I -{- I I I � I ,.! _ � - ! I •'.;- �; �� :�.� ' {. � -t- _r".___.�.. i ! f I_'— ! I I � ` ! 1 .. ...�.. ..--q- I .7-- �I- ,�_— - -;_. -'i,�_ , —, �— — - - - -- — ���:: ,rte•-�?�'d'';. .__- _.. I � f 1 J � I I ��� '- i..•. I ! I I I i ;y 1 _� _L_ _i� i._ !—' I.... 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