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HomeMy WebLinkAboutBuilding Permit #795-11 - 600 OSGOOD STREET 5/27/2011Permit NO: / l� Date Issued: BUILDING. PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received O' St`eD ib •N\ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: I Commercial Others: Repair, replacement Assessory Bldg f -o -n4—( r f' Demolition Other Septic We' 111 1=loodplain Wetlands Watershed D_'istrict Water/Sewer ur..Otomir 1 tun ur VVUMrt I U BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: :K% r,-) N{'?a//i c a Phone: Address: 0 e a Co cc �Al CONTRACTOR Name�srrt% Phone:` -9 `b' l 4 Address:' 7 -SFS CC` lc.� ., r Supervisor's Constructionliceinse:O t- , Exp. Date: 7 Home Improvem p ent License: Y s Ex Date. ' r .. 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: $475-0— FEE: $ Check No.: Q / S t� f Receipt No.: // NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignatru a of Agen, u wner Signature iof.contracto g , 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 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 el Planning Board Decision: Conservation Decision: Comments 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 z Fire, Department signatureldate,_: COMMENTS g 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 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 ❑ Notified for pickup.- Date Doc.Building Permit Revised 2008 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 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 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 2.2008 Location 6,�o No. �% l ' �� Date S i1� MaRT� TOWN OF NORTH ANDOVER - _ L 9 ;a Certificate of Occupancy $ .....: "� .s d �ss�cMuSEt - Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check -# 0 24sb,4 Building Inspector J O z m W ct x v o w v cn o U C7 A or- o w o w v x U CIS w ° U o. PO o w G W. a. o W wbiow 'AG o w CA Cd a. a O H d w w w A w ° z �o cn i - Q cn cO O as O 7 O CO Cc v L) ; C7 c.c A �1 co c :.c c ;off al CDL 47 / /l ©• O O v Q : V m ECLca L CD cm O c+ $ CD `© V� 1 L a9 O ca e CD CA C m C cc C ) c '1 7 cc O o Em U �•mo o -v m44 r^ m •v N_ A �O L Z O o� •� cm H m y m C •C i ® :CD 3 N F- o y m$� m COD r r.+ r.+ •V dt O C Z m "� o .y co LD ie CODd m� O� = A �Mw o� O s 0-m m z t O P a O O O v Z O. 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P. 02l /l 1�%1 1 t :J `� (II'� C.,.,' OtT.I '�:T'.. ,:t• 7 S ii: ;i; , it[`[' :`nll!Clt1`'lf: 11itlidf '( [n i c /T ;t `t .3Jo�C-Ill's'. t(it"c;,f_•ti.`f:� .,_.T T Itl aDl (I3usines r0rgani ationAndividl'3 f'i 7 ):_y���) �' Address q�LZ�1aJ City/Stale/Zip:1 PS 'K _11� Phone : 2 Are you an employer? Check the appropriate box: 1 am a ennployer �o i'}r�Cf� ❑ I af;n a general contractor and 1 <_.....:.i 1'•,'.il.-iS...? i�.:. ii.,d t!le Sii'i-G=';it?aC!:p]-C 2. ❑ I am a sole proprietor or partner- ship and have no employees Nvorking for me in any capacity. [1\10 workers' comp. insurance. required] 3. ❑ 1 am a homeowner doing all wort: myself. [No workers' comp. insurance required] 1 listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance, = 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c_ 152, §i(4), and we have no c.nployees. [No workcrs' comp. insurance required] Type of project. (required): 6. ❑ New consh,rction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions •14.❑ Plumbing repairs or additions 12.0 Roof repairs 13. .Other��- *Any applicant that checks box 111 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 sbowing the name of the sub -contractors and state N:fiether or not those entities have employees. If the sub-centracters have employees, thev must provije their workers' comp. policy number. P MW n -/'z crlp16yer that i,; provi['%rg workers' compere ration insurance for My eaployees. Below is thepolicy and job site information. Insurance Company Name: t: Policy or Self -ins. Lic. Expiration Date:/y Zi Job Site Address: &&-Lo C Q 0M W City/State/Zip: Attach a COPY of the workers' compensation policy declaration page (showing the policy r_umber 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. Ido hereby certify under the poirzs ar penalties of perjury that the irzforrzation prwirl(,d above,,is true ttnd eorrect. Official use only. Do not ivrite irz this area, to be completed by city or town offrciaL ci2.; as- Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing t::::r;ector 6. Other Contact Person: Picone #: a } �lassachusctt� - Department of Puhlir safety Buartl of Builtlin., Re--ulations ant) SCantl�trtls Construction Supervisor License License: CS 60219 1 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2013 ( mmi.cimcr. Tr#: 13389 CERTIFICATE OF LIABILITY INSURANCE CA TE(WtA,'DO,'YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON10/5/2010 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVER, HE BELOVV. THIS CERTIFICATE OF INSURANCE c CERTIFICATE HOLDER. THIS RAN CE DO S NOT CONSTITUTE A CONTRACT BETWEEN THE A AFFORDED -BY THE POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER- SUING INSURER(S). - ER(S), AUTHORI�Ef. IMPORTANT: I!IS the certificate holder is an ADDITIONAL INSURED, the policy(iesj must be endorsed. If SUGROGATI(}n the terms and ccnditions of the policy, c0r„in pofic,cs may req:Iire an endorsement. A statement on this crtrtif OG dot's not Confer ri eertificale holder in lieu of such endorsemont(s). a'VLO suo)='c( PRODUCER gn15 IO Ih- cDNTA r N.ichael FonaCorso Bonacorso Insurance Agency, ;TIC NAME: - rrloNE 83 Car.%ridC.2 Strc• t I(Ac.io.Exp:-(781)273-3200 FAX EMAIL .Hike ? (H:c, x (75:)'-1 F.O. scr 1 0 DDRESS. @bonacor-__jr1S.0 a: i R00u_ER 00003879 Burlington MA 01803 CUSTOtv:LKIDp. . �uRED INSURER(S) AFFORDING COVERAGE iINSURERARepublic Franklin Ins. Co NAIL tv Peterson Party Center, Inc. IINsuRERB:Travelers Indemnity 139 Swanton Street INSURER C Hartford Insurance Co. INSURER D: Winchestert A 01890 INSURER E: CcoVEI2'. ,INSURER F: is L1:iJlriRcR: i._ THIS IS TO CERTIFY THAT THE POLICIESRl— INDICATED. NOTWITHSTANDING ANY OF INSURANCE LISTED BELOVvHA E BEEN ISSUED TO THE INSUR p NAIAED ABOVE FOR THE POLICY PERIOD Ori :;ilf1..._:.. 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 CONDI TIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR .. ... ..._._ _----,.__..._._.._ LTR TYPE OF INSURANCE ApOI SUBR. ---- -- ---- - _ _ POLICY EFF P GENERAL LIABILITY IN !` WVG' POLICY NUtJBER OL1CY OCP- tJf.1'DO KV41OD/YY Y LIMITS X COMMERC AL GENERAL LIABILITY EACH OCCURRENCE c 1,00o' c' 10 DAMAGE TO RENTED A CLAIMS-rteAOE X OCCUR X X TPP 436 PREM,ISES(Ea occurr S - GENIAGG::EG:.TE _�WITAPrL� IESPP PoL1CY X 'ELI LOC AUTOMOBILE LIABILITY ANY AUTO B ALL OWNED AUTOS X 1SCHEDULEDAUTOS x ! HIRED AUTOS -X ; NON-O'Mf�EOAUTOS A A X UI.^.8REL1A LIAB 1 OCCUR UAB A8 ) _ CLAIMS -MADE; DEDUCTIBLE 1629 10/9/2010 10/9/26r 1 -"---- -- --- nce) 500, 00 >, MED EXP (Any one person) S 10,00 PERSONAL & ADV INJURY 1,000,0,_ - GENERAL ,000,C0GENERAL AGGREGATE 2, 000, 00' PROGUC7S GOO, _ X X 9296RG36 X X V.'OR=:_: F. S C n?w, F C,•s=. TTOY AND £7d3'LOYEFE— LIAEIUTY ANY PROPt!ETO-iPA rKE=LEXECUTNE Y!H OFFICEF,V.-EMBER EXCLUDED"; Z\ NIA: ((Mandatory In NH) If ves. desrrit—,— C Equipment Floater IUMB 4361631 7- WC 4361630 X } O BE DETERtK11dED 9/2010 <.,ii :Leased and Rented Equip: DESCR!PTIC`,,O`- OFERt.P014S f LOCATIONS I VEMCLFS 100.000 Li it 1 ORC 7G7, AddGi x al Remarks Scneduie• if more space ie Evidence o£ Coverage. required) CFRTIFIF`ATT= unr nrn A,CORD 25 (200.. ; NS025 (200909) CANCELLATION 1,000,0 1,000,00 1,000,00 5,000,Oo 5,000,00 500, co 500,eo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael J. Bonacorso The ACORD name and logo are registered marks of ACO, -;),.RD CORPORATION. All rights re. i COMBINED SINGLE LIMIT (Ea acbde�T) S 1.10/9/2010 110/9/2011 ! BODILY INJURY(Perperson) S--"- - BODILY INJURY (Per ,codenq S - . PROPERTY DAMAGE - (Per accident) $ Undennsured mutons; E! un Hsu ed ",-tons: E, S_I::. n; _ I EACH OCCURRENCc` S- - ,AGGREGATE x0/9/2010 ilO/9/2011 '-------------.. - 's S 'VC STATU- .TORY Uha;S, .. ..<<?, 110/9/2010 10/9/2011 F.EACH _ E.L. OtSEAS_E _ EA E_MPLO_YEE_ 5 ! E.L. OfSEASE - POLICY LIMIT S 9/2010 <.,ii :Leased and Rented Equip: DESCR!PTIC`,,O`- OFERt.P014S f LOCATIONS I VEMCLFS 100.000 Li it 1 ORC 7G7, AddGi x al Remarks Scneduie• if more space ie Evidence o£ Coverage. required) CFRTIFIF`ATT= unr nrn A,CORD 25 (200.. ; NS025 (200909) CANCELLATION 1,000,0 1,000,00 1,000,00 5,000,Oo 5,000,00 500, co 500,eo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael J. Bonacorso The ACORD name and logo are registered marks of ACO, -;),.RD CORPORATION. All rights re.