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HomeMy WebLinkAboutBuilding Permit #758-11 - 680 FOSTER STREET 5/10/2011BUILDING PERMIT of OORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '- Permit NO: 5O — l/ Date Received ^� Date Issued: l� �/ gcHuSE��y IMPORTANT: Applicant must complete all items on this -PaLye TYPE OF IMPROVEMENT I PROPOSED USE New Building Addition - Repair, replacement Non- Residential 'One famil 0 or more. family Industrial No. of units: Commercial Assessory Bldg Others: Other DESCRIPTIO OF WO K TO BE Pj�^q'EFORMED: f% s n - 11 1- —, A � 9 yam, �S t] _ 11 ♦ I entification PIe�se Ty OWNER: Name: 04. -4 -eN ih'Q G/�r/ Address: 6 9c) )0.q4e,' SA V or Print Clearly) e:. ?>9—v/9S-f 5' ass' ARCHITECT/ENGINEER Phone: Q Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. y Total Project Cost: $__ -7. FEE: Check No.: X %Z 3:: Receipt No.: NOTE: Persons contracting with unregistered contract is no�have access to the guaranty fund -Clq. Location�� No. 7 5�P v // Date f416Z r �oR,M TOWN OF NORTH ANDOVER - _ c 9 Certificate of Occupancy $ •, JACMUS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ s TOTAL $ Check # 24'1 4 /,,"(Building Inspector 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 k..Vivilvit=11 15 HEALTH Reviewed on Signature COMMENTS U � ' ' Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water $ Sewer Connection/ Snature Date Driveway Permit DPW Town Engineer: Signature: 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 Doe.Building Permit Revised 2010 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 ❑ 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 ❑Ce ifled 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: Building Permit Revised 2008 v X■. O S o w a chi A zo; G o w o r2 U G w" o w" W o w N w E.E o w G w m 8 c� U") o 0 .Co c :.0 H O C "~ O _J p_ C O O CD C ;= O O 1 CD r CD c 0 0 : m 0 o n v 1 N C ' E.E a c� H C: W 0 0 ^; V V w �%• mC y F-1 . r � v 1 CIO W H C: W V �%• y F-1 . H mm ca C4. �m C � Cc �cc N Cc m �E � w o ncj 4� h m C O Q j N 0 S y O O Z C � O m � Hn O C m p,=a3 O R m C .a�� . L y •E c, -o o .c 0 ® •— n 0-00.s AaC C, Z *_ n_.. m E Moa N Vl C O CD CD os C CIO O Cf C N CD :5 O Z O O I R v O S .1.4 Workers' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www, mass.gov/dia ensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Name (BusinessIOrganization/Individual): J4 1 Address: /� 0 1- City/State/Zip: Ci /State/Zi : / / oww Are you an employer? Check the appropriate box: Phone M 9 ;) Y-�/ _f - %7x��) 1. Lj�rarrt a employer with � _ 4. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' compo insurance compo insurance, t required.] 5. ❑ We area corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' compo insurance required.] or I have hired the contractor listed on the attached sheet right of exemption per MGL c. 152, § 1(4), and we have no employees, [No workers' compo insurance required.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[�oofrepairs 13.00ther * 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. iContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' compo policy number. I am an employer that isproviding workers' compensation insurance for my employees Below is the nolicv and iob site information. Insurance Company Name: Policy # or Self -ins. Lie: ! K� `r 131/ 91 91 6 0 , Expiration Date: �� f Job Site Address: (� Q 6 �•S'� �/ V �� f�� /S..s. City/State/Zip: � � 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 hereby certify er the pains and penalties ofperjury that the information provided above is true and correct. Signatur : Date: Phone• ? 7 D '-0 _ 2- o 4 � CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYI) 5/9/2011 THIS CERTACATE 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Circle Business Insurance Agency Inc 247 Newbury St. Danvers, MA 01923 1781639 (MM/DD/YYY1IIQU -I.) WNIAGI NAME: (A/�NNo Ext: 978-777-5619 FA/C,No):978-777-4898 ADDRESS:paulahalas@circleinsurance.net INSURER(S) AFFORDING COVERAGE NAICS INSURER A: Seneca Specialty Insurance INSURED Eric Teel 33 Hammond Street Rowley, MA 01969 BAG -1003222 INSURER B: Travelers Insurance Co. INSURER C: Continental Indemnity Company INSURER D: Torus Specialty Insurance INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTTRR TYPE OF INSURANCE I ADDL 8 POLICY NUMBER (MM/DD/YYY1IIQU -I.) POLICY(MM/DD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE NO I OCCUR BAG -1003222 12/20/10 12/20/11 EACH OCCURRENCE $ 1,000,000 PREMISES (Eaa occurrence) $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL BADVINJURY $ 1 000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY X JEIT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS X AUTOS NON -OWNED X HIRED AUTOS X AUTOS BA -8744N206 09/10/10 09/10/11 COMBINhU SINGLE LIMI I1,000,000 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) DEXCESS FIDED UMBRELLA LIAB LIAB X OCCUR CLAIMS -MADE 50663A100AL1 12/12/10 12/12/11 EACH OCCURRENCE s 2,000,000 AGGREGATE $ 2,000,000 RETENTION $ 10 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNERIFXECUrIVE oEFICER/MEMnER EXCLUDED? (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below N/A 46-819686 11/19/10 1/19/11 I WC STATU- X OTH- TORY LIMITS ER E.LEACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it morespace is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover Building Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 146 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 _ AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD lo, L.'llmIl2l, kNjassachtglietts - Department of Public Safet� Board of Building rieguintions and Standarchi Construction Supervisor Specialty License License: CS SL 99509 Restricted to. RF ERIC TEEL 33 HAMMOND STREET ROWLEY, MA. 01M aExpiraflow WAMMI TO- am ,--=Icape ; A TEFI ERI SEEI f-0 4W- -1 W 1 no - 12 er Affaiis and usiness RegWafion C-1-1 of Cc M11 tml lv�mS4-qhhusetts 02 Home Re!*stmaffon: 150,�6z-, Type: DBA &-Pimtfon: 41312012 Tit -4 2939U de=— CwL IN-, —nrk reason for chan ge- 1-0 RmerAd 0 Emptoymezit Lost.Care, revised 7/21/10 DEBRIS DISPOSAL CERTIFICATE -1 & Z FAMILY RESTRICTIONS ON THE ISSUANCE -OF BULLI) PERMITS MGL c-40, :S 54, Added by c. 584, S 9 of the;Acts of;1987 Every city or town shall require, as a condition of the issuing of a building permit or license for the demolition, renovation, rehabilitation, or other alteration of a builduig or structure, that the debris resulting from such demolition, renovation, rehabilitation, or alteration be disposed of in a properly licensed waste disposal facility as defined by section one hundred and fifty A of chapter one hundred and eleven. Any such permit or license shall indicate the location of the facility at which the debris is to be disposed. If for any reason the debris will not be disposed of as indicated the permitee or licensee;shall notify the issuing authority as to the location where the debris will be disposed. The licensing authority shall amend the permit or license to so indicate . AFFIDAVIT In accordance with the provisions of MGL c 40, S 54, a condition `of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. fi). 'JI) W�jlat4 "l-� PROPERTY ADDRESS The debris will be disposed of in: Board of Health LOCATION OF FACILITY Signature of Applicant Container Permit # Portable Toilet Permit # Page 4 of 6 • ERIC A. TEEL ROOFING Commercial and Residential • Fully Insured X978 479 7420 ig zh ESTIMATE SUBMITTED TO:A ; / ; 1 JOB NAME ADDRESS 1-12"- 'Is--." i , , i I JOB LOCATION ROOFING ESTIMATE JOB # i CITY/STATE2IP r DATE PHONE #FAX # CELL # WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES / PERTAIN TO YOUR ESTIMATE. WE AGREE TO: 1. COMPLETELY STRIP THJE ENTIRE OF THE EXISTING LAY RS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF ,v- EXISTING ONE LAYER OF HINGLES ON ❑ 3. INSTALL ANEW RUBBER ROOF(S), USING ALL NEW RUBBER ROOFING MATERIALS ON THE ROOF(S) SHINGLES OVER THE ROOF(S. CR 4. INSTALL NEW ICE & WATER SHIELD ON ROOF(S), ROOFS EDGE, RAKES, VALLEYS, DORMERS, SKYLIGHTS, CHIMNEYS, & FLAT ROOF AREAS. jq 5. INSTALL NEW � _ LB. ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE C9 6. INSTALL NEW 81NCH ALUMINUM DRIP EDGE ON THE ENTIRE NOTE: (IF) MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE, AN EXTRA CHARGE WILL BE ADDED FOR THE (LABOR & THE REMOVAL OF DEBRIS) OVER AND ABOVE—THE PRICE OF THE ESTIMATE. We propose hereby to furnish materiaWdla mplete in $ 8G' with payments to be made as follows: Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. ance with the Oe specifications for the sum of: d ��I Zip ' 1114 /0?"yj J'— Dollars_ Respectfully / 11/ 1/ Note — this prdp6gbrmay be withdrawn by us if not accepted within days 2rceptance of Propozal The above prices, specifications and conditions are satisfactory and are hereby Signature accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance i�g — o2O �( Signature