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HomeMy WebLinkAboutBuilding Permit #040-16 - 80 MAPLE AVENUE 7/8/2015 O� NO oT a qti BUILDING PERMIT �� y�::.• °� TOWN OF NORTH ANDOVER ° /°/ APPLICATION FOR PLAN EXAMINATION ; y Permit No: � Date Received �9SSg , Date Issued: r cNus���y IMPORTANT: Applicant must complete all items on this page ' ; y LOCATION D YY1 Gl )e V V ..' \ PROPERTY OWNER , Y1 � _, p.n Ck .(tel. S Print MAP N0: PARCEL: �bZ ZONINO DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid I , Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic El Well 0 Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer Identification Please Type or Print Clea%Pone: ) OWNER: Name: ��. S f Address: in IJ ' I� . CONTRACTOR, Name. ne: 7 7 Address: , C v 01 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. -Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. W FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST 8 E170N'$125.00 PER S.F. Total Project Cost: $ rT d FEE: $ Check No.: ff/'�)-- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac ce s o the guaranty Signattr`e of Agent/Owner ignature of contract BUILDING PERMIT o`"�oT"pro TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7° T Z y f - 0 Permit No#: Date Received wTr�W�p"y49 �SSACF!►15�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 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 ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ F—;1Septic ❑ Welt ❑a'FI'oodplain Di etNalf s; ; 5Wa ershedG+Distk cf I DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: s Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: � ' A Address: Reg. No. FEE SCHEDULE:BULDING PERMIT_$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: r Persons contracting with unregistered contractors do not have access to the guaranty fund 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 4� 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 OTE: 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 4. Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 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 Doe:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swnmlaing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster 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 i Conservation Decision: Comments � I i Water& Sewer Connection/S.Ignature& Date Driveway Permit w DPW Town Engineer: Signature: .� .� Located 384 Osgood Street MFIRE D�EPAR+TMENTi Temp Dum"steron�site� ,;ype5° at .? _ � p5 /SSS �' "'yti�e... tL•ocated at 124 MainStreet, Ftire Depamen�t signature/dates ro �✓ "i 4i e,,..�...�.•..: Alr...a••r4s�3f •J...:.f:.d,��,g7dJ.si. ; -- r� �' ywst' '��.`a�i'� +�.+'i,�'3T'� .13b`� • y �.-.-.n "'C�"^t7•�a�r"'�. R>.ir _....�._._.�...... ��` t��'-r��i-T2Jc�a�-.t t?' w$ • 1.�� .��"F.•r'R*..��� � ..i'h�l cr'-; �1 ♦ :t +'St���*xtc <�y.'-i trYa —''Scs 2 •'9r 2 r> � 'kap v��a",i� i °C®MMEIVTS�i�. � � r r• � ,. t. ,4•�< � �� � � �- `�^�, _ �' -� .�.L`� ;,�� � },s`�}�[ tai°,� t f 4� f`k e.� j ,•ry { 4 i 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 C DANGER ZONE LITERATURE: Yes No i MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use) i I ® Notified for pickup Call Email Date Time Contact Name _ Doc.Building Pennit Revised 2014 Location No. l DateW Sr I • • TOWN OF NORTH ANDOVER r Tb Mb Certificate of Occupancy $ - Building/Frame Permit Fee $ A Foundation Permit Fee $ ♦,' T L9G9AlYlCPEi%� �1 Other Permit FeeWrl $ TOTAL $, rf µ Check# ` Building Inspector 6.; NORT#1 Town of over 2oj�No. * t _ Mhver, Mass, COCHICHIWICK U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System /_ BUILDING INSPECTOR .. THIS CERTIFIES THAT ..... Q►.t.n:. ..... ........�C �!!.!�'�. .�.......4C.ilow.b... ................... � has permission to erect .. buildings on 0o, Foundation Rough tobe occupied as ... .. ...••t..... ...................�.. .... .................................................... Chimney provided that the person acc ting this permit shall In every spect 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 ONT LiS ELECTRICAL INSPECTOR UNLESS CONSTRU T S Rough Service ............. ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. CERTIFICATE OF LIABILITY INSURANCE DATE(MM//201.5 Y) TIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BALDWIN\WELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (A/C,No,Ext): (A/C,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: INSURER D: PO BOX 75 INSURER E: NORTH BILLERICA,MA 01862 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDMYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ EXCESS LIAB LJ CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-14 12/14/2014 12/14/2015 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? MN NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. JOB:ST.MICHAEL'S SCHOOL-80 MAPLE AVE.,NORTH ANDOVER,MA 01845 CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST,BLDG 20,STE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA .. NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER A.CORO� DATE(MM/DD/YYYY) `.� CERTIFICATE OF LIABILITY INSURANCE F7/7/2015 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). PRODUCER CONTACT NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office a"Co No Ext:(978)562-5652 FAX No; 978 562-7120 131 Coolidge Street,Suite 100 E-MAIL ( ) Hudson,MA 01749 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED INSURER B:Safety LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO Box 75 INSURER D: Billerica,MA 01821 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR NPP8237995 04/1312015 0411312016 PREMISES Ea occurrence $ 100,000 X Contractual Liabilit MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY FIJEPRCTO- ❑ LOC PRODUCTS-COM P/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO COM6230688 10/13/2014 1011312015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 CX EXCESS LIAB CLAIMS-MADE XLS0096729 04113/2015 0411312016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Workers Compensation coverage will be sent directly by the carrier. Job location: Saint Michael's School-80 Maple Ave.,North Andover,MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts-Department of Public Safety Board of Building Reguia.ions and Stand-r,'-4- / _.._...._ Office.nit" !�JrL nnsnmer Marrs. Be§inecstere! On R,1+tt>gl G-3G tit t7��S t.416'„sial- "s i- }H©ME IMPROVEMENT CONTRACTOR License: GS-079476 Regis trattton• 137913 Type. !, _ Expiration: 1127/2017 I�A6VRLNCE E MI tG -,. ,. 3 Indnadua'i 96 RM ERICA ASE r LAS VRENCE E.MORGAN J'R2 N BU I.,ERICA MA 0# _ LAWRENCE MORGAN JR. .86 BILLERICA AVE UNIT 1 ✓. ..- .b s }t"cs l' Ex iration p . N.BILLERICA,MA 01862 —'"-- ComMissioner 06/030017 Undersee"reta r v I I i I i aammr trsetat E+ 0 SH. This card ackriowiedges that the recipreht has suct*ssfuily complcted'e' 30-hour Occupationai SafeCy and Hsalth Training Course in _..... {�`ol�StYltCttPtiJ^iTe ety'Ah Health fins sut ce1 S^!ui(}c.inpietect r,1.J U,..tii,,t:l5 ?! 8fn l 4{n rin mitt ztg Cnlamr In i i ... Const uctiat�Safety&4 feaith {Trainetriame-pnnt,ortype) + 1 Dtld F�Gr-�tl (Ccuttse and date} r -._.... _..� ,I