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HomeMy WebLinkAboutBuilding Permit #313 - 586 OSGOOD STREET 5/1/2018 r10RTFI BUILDING PERMIT 01* TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y '° Permit NO-1-0 Date Received b `® °o AT�p �ssac►+us�� Date Issued: IMPORTANT:Applicant must complete all items on this page e-,� r �CAMON 7 rant ' .,- RPERT� OW�7 ER � ���� � � �° � 77777 7'. y 7�. ic� `'._ d r•. .,n' w t. '"`_* s' +d �'t-: ns¢5 t 6 - .�, TYPE OF IMPROVEMENT PROPOSED USE, Residential Non- Residential New Building - One familiD Addition Two or more family industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: /dpi°'-J Demolition Other ts�ami `fes �a �..+.�5''r'r.,..�:�" .c *'4�' 's} } ,tr S '`. �� �z w��.`��*� :_✓ � -i a'�.. 3�k^" y.hsa„xt,q, .�.. 'xr 4t +,,. �r� DESCRIPTION OF WORK TO BE PREFORMED: G C.�f✓ o.ti /�/s/� G �Xt/S'//r �' a mi -I 1 J Identification Please Type or PrintClearly) OWNER: Name: , A -Z� Phone: �&f,6'96 Address:1�7T j �su�.•'���'r- C0RACT,ORNarr�e : � � a ' nMr P g A a w" rpt '�-�„ Address ° ' 4 .e -ri it x x2+°� ra r• r w'�.€,�: r'.i s rx n�.' Hoxaie ARCHITECT NGINEER © �� Phone: Address: �/ a�'�ir �, � ��' G7 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: $ Ion FEE: $ � s � Check No.: /s"��J Receipt No.: � 2 f NOTE: Persons contracting with unregistered contractors do not have a ce s to the anty fund Sigrsature of Agent/ wner. = Signature of contracto Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL s Public Sewer Tanning/Massage/Body Art 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 _ D EJECTED DAT APPROVED CONSERVATIO COMMENTS DATE REJECTED DATE APPROVED HEALTH - 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 Drivew/ay Drive /ayPermit Located at 384 Osgood Street FIRE:DEPARTMENT Temu p Dmster on site yes :no .:Located at 124 Main Street 4 `Fire Department s�gnature�date COMNIENI''S ° r. 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-$1000 fine NOTES and DATA— For department use k i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for,the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work j o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks l o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses i ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require. sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan f L3 Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) C] Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location- of4©e-)j 3$ /© o`7 • No. Dater T MORTh TOWN OF NORTH ANDOVER ! .. o P � y • i ; = Certificate of Occupancy $ Building/Frame Permit Fee $ � Q sACMUS - t Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 2074- 1f� /4dalding Inspector SORT H TONNM Of over No. ill4r' ilk o dower, Mass., y1 7 T Q = LAKE � GOCHICHE.CK �®AORATED �S BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... Fr'U..r ......h.?. .... '`'� . ............................................:................................................................. Foundation has permission to erect........................................ buildings on ... ............................................. Rough to be occupied as ................. ... .... . ................, /1i6/`P..[!.......:..... :........................................................... 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 INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMF EXPOS IN 5 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N STARTS Rough .......... �. r-+................................................. Service oz 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 3 _ Board✓ 1 B ilomdi�g Rer(s an✓d�a r�� x, Construction Supervisor License License. CS 76339 L , ¢ + Birkhdate77711946 TO 16528 _. Expirat o71712Q09 t n 00 Rest{ict+o ... s'= ROBERT J FISKE `€4 5 TANGLEWGOD PARK "J" "f Commissioner HAVERHILL,MA 01'830 �. - Jl��o�•nm�uvea�o���' .c`audel,�6 Board of Building Regulations and Standards Licensebefore t lugHOME IMPROVEMENT CONTRACTOR Board c Registration:=105485 { One As', Expiration 7/1772008 Boston, }. Typ-0- Supplement Card qq SOUTH SHORE GUNITE POOL- I PF)t9 'T FISKE p 7 Progress Ave. Chelmsford,MA 01824 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei!ibly Name (Business/Organization/Individual): L.S WMIUQ�w Address: /l City/State/Zip: 6 ey i Phone #: n o AWimarn an employer? Check the appropriate box: Type of project(required): 1. a employer with /,?0 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ T am a sole proprietor or partner- listed on the attached sheet. 7. 0 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 ME] 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.] t employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 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 a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: Policy#or Self-ins. Lic. #: �XD/ 3a3� Expiration Date: Job Site Address: J��G Us tcd ICity/State/Zip:A14ZU6ot 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebycerti er th pains and penalties of perjury that the information provided above is true and correct. Signature: Date: a—Z& 0- 3:7-Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# 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#: Date: 10/18/2007 Time: 10:05 AM TO: Town of n AIluvv— c. Y ---- Page: 001-002 DATE(MWDDIYYY`) al.L-1LJ[�i+�e, CERTIFICATE OF LIABILITY INSURANCE 10/18/2007 PRODUCER (603)432-3666 FAX (603)432-6076 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEION Lakeside Insurance Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR One Wall Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Windham, NH 03087INSURERS AFFORDING COVERAGE NAIC# INSURED South Shore Ganite Pool & Spa, Inc. INSURER A: Acadia Insurance 31325 7 Progress Avenue INSURERB: Technology Ins Co Chelmsford, MA 01824-3606 INSURER C. INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CY EFFECTIVE POLICY EXPIRATION INSR POLICY NUMBER Wpp UNITS TYPE OF INSURANCE 1.000.00c NS GENERAL LIABILITY CPA014582511 04/01/2007 04/01/2008 EACH OCCURRENCE $ AMA s 2SO,0001 X COMMERCIAL GENERAL LIABILITY PREMISE ca) CLAIMS MADE a OCCUR MED EXP(Any one person) E 5,0 PERSONAL&ADV INJURY $ 1.000,0001 A GENERAL AGGREGATE S 2,000,04 PRODUCTS-COMP/OP AGG S 2,000,000 GEN'L AGGREGATE LIMIT APPLES PER POLICY X JECT LOC AUTOMOBILE LIABILITY MAA017724810 04/01/2007 04/Ol/2008 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) A X SCHEDULED AUTOS X HIRED AUTOS (Per a erd) S (Per accident) X NON-OWNED AUTOS PROPERTYDAMAGE S (Per acciderd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG 5 EXCESSIUMBRELLAL MILITY CUA017913810 04/01/2007 04/01/2008 EACH OCCURRENCE s 2,000,000 X OCCUR CLAIMSMADE AGGREGATE S 2,000,000 S A s DEDUCT®LE g RETENTION S _ WORKERS COMPENSATION AND TWC3134266 04/01/2007 04/01/2008 X ORSLA S ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 1 000 OO B ANY PROPRIETORJPARTNERIEXECUTIVE E.L.DISEASE-EA EMPLOYEE S 1,000,00 OFFICERMIEMBER EXCLUDED? C es.describeunder E.L.DISEASE-POLICY LIMIT S 1 000,00 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS overing the installation of swimming pools and related operations of insured during the policy peri oma Owner: Mark Barbarian, 586 Osgood Street, North Andover, MA CERTIFICATE HOLDER CAN ELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 1_DAYS WRITTEN NOTICE?TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Town of North Andover OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. N. Andover, MA Fseph HORIZED REPRESENTATIVE Rossetti/GARSA ACORD 25(2001108) FAX: (978)688-9542 OACORD CORPORATION 1988 TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: Est. Cost Address of Work Owner Name: 4�i�/�,� / e� •�� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND U L c. 142A. Signed under penalties of perju hereby apply for a permit as he agent of a owner• Date Contr9ctor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date 3wner Name I I