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HomeMy WebLinkAboutBuilding Permit #296-16 - 8 WALKER ROAD 9/8/2016 Sc9 AtWC--P q/J/ BUILDING PERMIT r1oRTt1 q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �/ Date Received �qss AnD Date Issued: — r IM ORTANT: Applicant must complete all items on this page LOCATION �j LO°y �� �.r�► ��+Ul�'�' `�' l 'U�v�IG.+/� b i Print PROPERTY OWNER Print 100 Year Structure yes MAP PARC 'r- ING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family j ❑ Addition *LTwo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �vw� �-� o -��Ge , av►c� cv�,�x.11 iA ArZ. -�►l-e_ Identification- Please Type or Print Clearly ��� OWNER: Name: Phone: Address: Lk) ` U V61 Contractor Name: Phone: 0 "794^ ` / 7 Email: Address: (o,,!q KO&Cvllgrw Supervisor's Construction License: 02C /7n Exp. Date: / II Home Improvement License: 11917 Exp. Date:lO ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BA D ON$125.00 PER S.F. Total Project Cost: $ 6 FEE: $ Check No.: � Receipt No.:�� ) NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun ' 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 OFW - 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 Fiaiining Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE0ERA RTMENT - Temp .pumpster onsite ,yes _Jno _ k _ .. + li atedjat iU405ihiSt�eet Fire�D;epartmentagnature/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-$1000 fine NOTES and DATA— (For department use LI Notified for pickup - Date E t t Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application rE Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 6 Certified Surveyed Plot Plan ,4. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No.,096 Date • - TOWN OF NORTH ANDOVER • f LED Certificate of Occupancy -$ Building/Frame Permit Fee $� } Foundation Permit Fee $ v Other Permit Fee $ TOTAL $ , Check#�6�1J1 Building Inspector r 1 NORTH - c . . ve" - No. o0- h , ver, Mass, LAKI .Q coc Nic"t WICH 1• ACJ 'ATEO S V BOARD OF HEALTH Food/Kitchen PERMI LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . Foundation has permission to erec8'wxumlvw� .................... buildings on ...... ....... ..... �. Rough to be occupied as ....... . ... �. ..0............................................................. 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 ONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCT S S Rough Service ........... ... ...... ..................................................... 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. Tran Fully Insured MA License #143543 617-794-0797 CS: 096170 Fully licenses &Insured 64 Robertson St. Call for estimates & Quincy MA.02169 W sA0-F r Ideas Con tructi riLLC Date: Owner names: A ' Contact information: (7 _ CD Address: q j5 P Work site address: Scope of Work: C{�s f S-l1 ,-- dexy .Wj k�: CA,," <Q ldn 9�0 V2 C-12—w± M (A ; C�C NOTE: All workmanship is under warranty for 1 year. We propose hereby to ish maul and labor-complete in accordance with above specifications,for the sum of $: Payment Schedule: I. Deposit for ordering material $ 11. Start work $ III. After completion of 1 week $ IV. After completion of work $ i. TOTAL $ d CID All material is guaranteed to be as specified.All work3e Ompleted in a workmanlike manner according to standard practices.Any alteration or deviation from 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. Owner to carry fire,tornado and other necessary insurance. Authorized Signature: '.Zr _______ I Note:This proposal may be withdrawn by us if not accepted within_7 days. Acceptance of Contract.The above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the w rk as specified.Payment will be made as outlined above. Date of Contract: Signature Signature The Commonwealth ofMarssachusetts Department oflndustrialAccidents .l Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia SJR Wovkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE MED'WITH THE PERMITTING AUTHORITY. Ap licant Information Please Print Legibly NaME)(Bttsiness/organizationlln.dividual): �_ CLAW- � ' _S 1� .Address: PL City/Mate/Zip: Phone##: . . Are you an employer?Checkthe appropriate box: 'Type of project()required): 1.QIamaemployer with employees(fulland/or parttime).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in &. [1 Remo deliAg any capacity.[No workers'comp.insurance required_] 9. El Demolition 3..❑I am a homeowner doing all work myself,[No workers'comp.insurance required.], 10[]Building addition 4.❑I am a homeowner aadwill be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions pro'p'rietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractoras listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.[[We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Othbr 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box4l must also fill out the section below showing their workers'compensation policy information. i homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. ?Contractors 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 fiave employees,they must provide their workeis'comp.policy number. X ane an employer that ispidviding workers'compensation insurance for my employees'BelOw is thepolicy and job site information. Insurance Company Name: ,e--, Ct. Policy##or S elf-ins,Iac.#: C_ Expiration Date: Q, -�,� e]- X11.-x/11, ty/StateM Job Site Address: 97 � � Cz p' Atta&a copy of the workers'cbrapexnsation'policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert der pa'is andpen lties ofperjury that the information provided alcove is true and correct. Si nature: Date: ` Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License 4 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#: �.•�� TAMTR-2 OP ID:JG `�,.���® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI� 10/22/14 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 A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ACT PRODUCER 978-975-1300 NAME: Segreve 8r Hall Insur.Assoc.lnc 978-975-7596 PHONE FAX 305 North Main St. A/c No Ext): A/c No): Andover,MA 01810 Patrick D.Hall ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Commerce Insurance Co. 34754 INSURED Tam Tran INSURER 8:AEIC 11104 64 Robertson Street Quincy,MA 02169-1217 INSURER C: INSURER D: 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. INSR TYPE OF INSURANCE POLICY NUMBER MM/LIDDY EFF POLICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY BGKDXT 09/11/14 09/11/15 DAMAGE TO FU- PREMISE occccurrence $ 100,000 CLAIMS-MADE F1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 71 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acadent UMBRELLA LIAB I OCCUR EACH OCCURRENCE _ $ EXCESS LIABI CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY TCR LI R _ B ANY PROPRIETOR/PARTNER/EXECUTWE Y❑ BI 09/11/14 09/11/15 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION 0000000 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �a ��e�po�nUrno�rzcueaCC�o�C�aac�cu,eGti -- --— _ _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only (1 OME IMPROVEMENT CONTRACTOR before the,expiration date. If found return to: egistration: ,A78976 Tye e: Office of Consumer Affairs and Business Regulation xpiration:c_:_6 /6/20-46--- DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 TRAN CORNER STONE'GENEFM CONTRACTOR TAM TRAN 64 ROBERTSON STJI QUINCY, MA 02169 4 Undersecretary Not valid without signature 3 > Massachusetts -Department of Public Safety j Board of Building Regulations and Stas dlyds. Construction Supenisor License: CS-M170 Tan V Tran - 64 Roberton Streef Quincy MA 0216$ Expiration Commissioner 05/05/2016