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HomeMy WebLinkAboutBuilding Permit #1051-15 - 73 FOREST STREET 6/15/2015 Z� L �UlDING PERMIT o� NORTFh q 32 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION , nO Ob Permit No#: Date Received �p"�RwTeo c5 gSSACHl1`'�( Date Issued: IMPORTANT: Applicant mustcompleteall items on this page LOCATION 73 � ,1de'w— 10—� rin PROPERTY OWNER /�.t7T/f�isJ 4ArA ,We1� n+ - Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building /,,One family ❑Addition Two or more family El Industrial El ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District [I-Water/Sewer _ DESCRIPTION OF WORK O BE PERF MED: Identifi ation- Please Ty a or Print Clearly OWNER: Name: � Address: 7�3 �� !.- / ` Old ContractorName:—`-� S Phone: Email: —E:> Address: Supervisor's Construction License:CS Exp. Date: Home Improvement License: 133�� 0 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��'' FEE: $ c1. off' Check No.: ��g� Receipt No.: a�'l2 5"' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location 7 No. !" /r Date ,- . - TOWN OF NORTH ANDOVER ED Certificate of Occupancy $ Building/Frame Permit Fee ' Foundation Permit Fee14 $ f Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ To Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp_Dumpster qn.site ,yes_. .. _ no Located at 124,Mbin.St�eet Fire-De p.artment 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 .r. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work :r Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 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/Cross Section/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 OTE: 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 .r Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract .� 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 NORTH Town of 1 EAndover No. h ver, Mass, cocHic..C..C. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System N7 f� Gf(l.'� /�( , BUILDING INSPECTOR THIS CERTIFIES THAT ...1..J. ........?...................... ....... t!:7. .!:................................ ...................... has permission to erect buildings on ,,,,(]; '{;.�; Foundation .......................... ..��...� ...................... Rough to be occupied as ...............................................` G l� y ...... ..................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCTION STARTS Rough ,....... ... Service ................ .... .-(� . .�J..—:................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. Frageo Enterprises LLC dba European Quarry Imports 326 South Broadway Salem NH 03079 603-894-6888 fax 603-894-6887 tL�'#i'.€'rdt"fJt't7d1t�€"?.!Ldll�'ii17�C�t't.�,t'ofYt E-mail int<� aa? j�er2cp ZaLt aye t1? lf'D t 4`.C.'C?t$ Date: June 15, 2015 To: Matthew Wolstromer 73 Forest St. North Andover, MA 01845 Subject: Contract for remodel of second floor bathroom. Scope o f work: Remove toilet, vanity and existing flooring. Install cement board and the bathroom floor. Install new vanity and granite countertop. Replace toilet and hook up vanity sinks. Total cost of project is $ 5,783. eorge Kenne Matthew Wolstro er CERTIFICATE OF LIABILITY INSURANCE u� UU 9/9/2 01 4 ' THIS CERTIFICATE 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 endorsement(s). RODUCER ONT NAME: Amy Martineau COMMERCIAL INSURANCE SPECIALTIES LLC A/c°,No,Ext: 603 566-9519 (AAcc,No):603-232-185 855 Hanover St PMB 268 ADDRESS: amy@ ahm-cis.com Manchester, NH 03104 INSURER(S) AFFORDING COVERAGE NAIC#. INSURER A: First Comp Insurance Co , ISURED European Quarry Imports INSURER B: 326 S Broadway INSURER C: Salem, NH 03079 INSURER D: (603) 894-6888 INSURER E: INSURER F: :OVERAGES 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. POLK;Y EXP rR TYPE OF INSURANCE INSD %WD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMA EACLAIMS-MADE CI OCCUR PREMISES(Ea occurrence) $ ' MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY jE O CI LOC PRODUCTS -COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY Ea accident) $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR FI CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X I PER - AND EMPLOYERS' LIABILITY STATUTE ER OFFICER/MEANY PROPRIETOR/PARTNER/EXECUTIVE Y❑NIA WC0157097-01 9/9/2014 9/9/2015 E.L.EACH ACCIDENT $ 100,00( A (MndatoryhInNH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ ZOO,OO Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) :ERTIFICATE HOLDER CANCELLATION 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 1 ©1988-2013 ACORD CORPORATION.All rights reserved. ,CORD25(2013104) The ACORD name and logo are registered marks of ACORD I C tIVIIVIIUUI I I I I/ Lip CERTIFICATE OF LIABILITY INSURANCE 9UH /9/2014 THIS CERTIFICATE 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 endorsement(s). RODUCER NAME: Am Martineau COMMERCIAL INSURANCE SPECIALTIES LLC PAIC.No,Ext: (603) 566-9519 �a.No>:603-232-185 855 Hanover St PMB 268 L-MAIL s: amy@ahm-cis .com Manchester; NH 03104 -ADDREINSURER(S) AFFORDING COVERAGE NAIC#: INSURER A: First Comp Insurance Co ISURED European Quarry Imports INSURER B: 326 S Broadway INSURER C: Salem, NH 03079INSURER D: (603) 894-6888 INSURER E: INSURER F: ;OVERAGES 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. Ink TYPE OF INSURANCE ANSD wVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYW) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR PREMISES(Ea occTOTEurrence) $ MED EXP(Any oneperson) $ �GENERAL NAL 8 ADV'INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: AGGREGATE $ POLICYFIJECT PRO-- CI LOC PRODUCTS -COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY $ Ea accident ANYAUTO BODILY INJURY(Per person) $ AOFI SCHEDULED AUUTOSS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC0157097-01 9/9/2014 9/9/2015 E.L.EACH ACCIDENT $ 100,00( A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,001 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) :ERTIFICATE HOLDER CANCELLATION 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 1 ' © 1988-2013 ACORD CORPORATION.All rights reserved. 1CORD25(2013/04) The ACORD name and logo are registered marks of ACORD 0211 /rLY/2dI'LCl1ULGcy7.d U(�GC!'d1CGCf2flJ8 ! - Office of Consumer Affairs&Business Regulation License or registration valid ior.individul use only ME IMPROVEMENT.CONTRACTOR before the expiration date. If found return to: a egist:ation: 133648, Type: Office of Consumer Affairs and Business Regulation xpiration: 7/23/2015 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 DONA!.D R.PERKINS DONALD PERKINS r 4 MEADOW ST.APT#B l NATICK, MA 01760 Undersecretary - Xgt,,yalid without signature 1 Maasachusetrs -Department of Public Safety (' Boz?d of-Building Requlattoj&.*o d gtand Cnrist'rue`tiohSSeoenNor '` : .«'c ,... . License:, CS-042333 DONXIff R PER ONS. 4 MEADOW ST AtS r' '7 Natick MA 0176tF �. r�.S �\ Expiration Commissioner 08/22/201'6