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HomeMy WebLinkAboutBuilding Permit #486 - 704 FOREST STREET 12/15/2010Permit NO: Date Issued: r-'� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Date Received must complete all items on this LOCATION ,�/ Print PROPERTY OWNER TO.SCoO / Print MAP N010 CEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building 12,6ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septics 0 e11 ®Floodplain 3 ®W�etlandsj y _ ®VUate"`rshed Ds�, J ®Water/Sewers 14 DESCRIPTION Or WOKK TO 13E PERFORNFPD: 1?Gn?Oa2LXisi"in/G� Identification Please Type or Print Clearly) OWNER: Name: V Niel �/ Ze'l&Z % Phone: Address: CONTRACTOR Name: /� �jOSL��/� f�l�%j� / 1e Phone: 9,V ����lO/`' / Address: S�V A� %-yeeh/2al Supervisor's Construction License: /SDDY Exp. Date: RI -27/a0/% 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 $925.00 PER S.F. Total Project Cost: $ a� � FEE: $ Check No.: 6 %/? Receipt No.: a3'�--�1 7— . NOTE: Persons contracting with unrezistered contractors do not have access to the guaranty_ fund Location No. Date "O"Tol TOWN OF NORTH ANDOVER p:,...° ,• gyp F w a i y ' ; . Certificate of Occupancy $ Building/Frame Permit Fee $ I JACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23792 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED a DATE APPROVED Reviewed on Siq_nature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comme Zoning Decision/receipt submitted yes 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 Fire Department signature/date COMMENTS 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) ❑ Muss 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 ❑ 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 VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 'n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording oust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi 0 O o T m rn C cs�o o . O —• i/J 5 y H C d o o C7 9 m Z m O Cos n tz Z = m m O 0• . CL r c m m 0 CD S! a c CO) m n cc O O Z�•n Oo � M X CD Z CL O N c� S m CD CD CD a ,... O CCD y. w O H -� d CD CO) ,om O m CLte. CO CD S H O 10 O Z O ,..f H a c O o CD a N 0 C � ...t CA CD 0 O o T m rn C cs�o o . O —• i/J 5 CUR H d0,,4® CD .p to ® o o C7 9 m Z m co Zr, La cm o tz m s d = m m O ®y y . O CD p 2 N o 0 CD S! a c CD Z�•n -� O y� n O =r S ya = 1C a ,... O w O H CD ,om m CLte. v' H a c o .W 9 a N C � ...t CA m H y m ® C . dCA CD - �C.) oo • H -v o CDCD S* i CA so ixm o CD 1) o a'o �n o �+ _ G COO o M: = cD p ro d `� z p . Pal w 91 x H w Ct7 m ro oda �' tom" �'- aGc a' 00 w 0 tz ro• ; A+ .�+ O 2) • 9 0=3 0 0 c J te�a%% e eCo sumer�� dsines� to Office - HOME IMPROVEMENT CONTRACTOR Registration: -,.00294 Type: Expiration: :x '012 Private Corporatio V'ERJ.RAT7 ED �}mi' Joseph Ratter 340 Mt. Vernon St .�,= moi! Lawrence, MA 0184i . Undersecretary Massachusetts - Department of Public Safety Boafd of Building -Revelations and Standird Construction Supervisor License Licenser CS 15004 Restricted to: 00 JOSEPH R RATTE 340 MT VERNON ST LAWRENCE; MA 01843 ��--�— -� Expiration: 8/2712011 Conmissiuner Tr#: 20364 . M� .Giis,sfiifwealI1 of Nasse. zuseas -Depanbnent &J-hidustriaMccidents r •— Office ofInvestigations 600 Washington Street' ., .� Boston 1K4 02111 www.moss gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationP3ease Print Legl'bly Nama pusmess<organizatio idmo: Pe Address: 3/-/,/) /V S/W//e'f%7% e M/�l 69/g1Y,� City/State/Zip: Phone #: Are you an employer? Check the appropriate box: I. f.�J t am a employer with 0? `l. I am. a general contractor and I employees (fall andlorpart=time).* have hired the sub -contractors 2. ❑ I am a sole proprietor orpartner-. listed on the attached sheet ship and have no employees These sub -contractors have working for mein any capacity. employees and have workers' No workers' comp- insurance 'comp. instuancet required.] 5. ❑ We are a corporation and its 3.E1 I am a homeowner doing all work officers have exercised their myself. No workers' comp: right of exemption per MGL insurance required.] t c-152, 61M. and we have no employees. [No workers' comp. fasuvtnce Mauired.i Type of project (required): 6. ❑ New construction 7- DICemodeling 8. , ❑ Demolition g. ❑ Building addition 10.01 Electrical repairs or additio I I.❑ Plumbing repairs or additio 12.❑Roofrepairs 13.❑ -Other '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 nffidavit inacarmg such. tCantractors that check this box must attached an additional sheet showing the name. of the sub -contractors and state whether or not those entities have employem tithe sub -contractors bavc employees, they mustprovide their workers' romp. policy number I am an employer that isproviding worlwxs' compensation insurance for my employees. Beloty is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lir. M -- "A, �/ %� � J Expiration Date: it Job Site Address•;® , /L©%c'e-5-1— STsU� ��ile 44tateizip: ®`oa7 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 fi of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an altieWpm jury that d ormadon provided above is true and correct Official use only. Do not iw*e in this area, to be completed by city or im m offudaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. ]Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector S. PIumbing inspector DATE (MMIDDIYI LIASILITY INSURANCE c© CERTIFICATE OF iE 05 24/: THIS CERTI TE IS ISSUED ASA MATTER OF INFORMATION PRODUCRATTE ER AND CONFERS NO RIGIM UPON THE CERTIFICATE .. ONLY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Michaud,' Rave And Auscak Ina ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.O. Box; 18$ North Andover ,MA 01845 phone: 976 688: 8829 Fax: 978 557 2130 MURERSAFFORDINGCOVERAGE NAIC# orso RED .... INSURER ...,>Ml�stid Muenal 7tawraadA Ce 15024 :. tNsuRER Lt : 'Safet Ia6trance .0 axt 12808 INsuRER G ` American Iaternttsonal` COS :. Ro r J Ratte,,2ne 340 . Mt . Vernon 8ts�eet 0184w.3 INsuaER D- Lawrence MA 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 MAYBE ISSUED OR MAX PERTAIN, THE INSURANCE AFFORDED BY THE PdJCIES. DESCRIBED HEREIN Is summa TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE-SM REDUCED BYPAID CLJ11Ms. LTR R TYPE OF IIGZURANCE POLICY NUMBER . DATE 0 EXPIRATHM DA E ��$'SOOOOO ' GENERAL LIABILITY CO MMERCIALGEN&MLUABIUTY CPP0110594188 . EACH OCCURRENCE PREMISES EaoccW01ce S 50000 CLAIMS MADE OCCUR MED EXP.( one person) $ A X.'Suaineas Oas><era 03/28/lp 03/28/11 .PERsoNAcsADVINuRY' s500000:.` GENEWUeAOf3REGATE : ':- $ 1000000 f o PROOUCTs COMP/OPAGG $ 1000000 GENLAGGREGATE LIMIT APPLIES PER: POLICY .. ` :.. JEC ' AUTOMOBILE LIABIldT11 I G1I1:8I1Q 01/16/11' COMBINED SINGLE LIMIT (Ea �eideM) S 8 ANvauro 1500030 — ALLOWNED'AUTOS BODILY INJURY $ 250000:` (Perpersan) x `SCHEDULED AUTOS �( HKiEbAUfOS BODILYINJURY $ 5500000 (Per acddent) X NON-0WNED AUTOS PROPERTYOAMAGE' $ lOO000 (Per accident) AUTO, EA ACCIDENT,.. $ GARAGE LIABILITY . OTHER THA N EA ACC S ANY AUTO AUTOONLY < AGG $ EACIiOCCURRENCE $ ". EXCESS IUMBRELLAIJABIUTY AGO RE{iATE. OCCUR D cLAiYS MADE $ E. DEDUCTIBLE $ RETENTIONWG5$ WORKERS COMPENSATION TORY LIMITS ":. ER " `- C ,- AND EMPLOYERS' LIABILITY .' ANYPROPaIETORIPARTNERiExEcuTlyL�Y-/-NI WC8944334 04/23/10 04I23I11. EL-EA- +ncclDENr $100000 OFFIC wMEMBER EXCLUDED? u EL DISEASE EA EMPLOYEE $100000 Ryes desPibe oder SPECIAL PROVISIONS below OTHER = ', E.LDISEASE POLICY LIMIT $ 500000 pESCRIPTION OF OPLJiATtONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCLLLED'BEFORE THE EXP BIDDINI OATS THEREOF, THE 1SsUtNG I MER WILL ENDEAVOR TO MAIL DAYS WF . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,:BUT FAILURE TO 00 SO WPOSE NO OBLIGATION OR J."JI RY OF ANY KIND UPON THE INSURER, ITS AGENT: 8iddinq . Purposes REPRESENTATIVES. - 77REMEMWA ". A ON All rights reserved. ACORD 25 (2009/OT) The ACORD name and logo are.registered marks of ACORD "., %J L, .. y "%..4,y W LAL Proposed Layout CONTRACTORS COPY _ RESIDENT 'CONTRACTING AGREEMENT