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HomeMy WebLinkAboutBuilding Permit #649 - 92 SANDRA LANE 4/8/2013BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4 Date Issued. IMPORTANT: Applicant must complete all items on this page LOCATIONiv { _ }^- PROPE,�RTY,WOW, NERt 6 �7 MAPaNO' 'PARCELt ZONINGDIS;TRIT Histonc�Dist�ict I e yes3 no; t 17._ ac m o �V I •� � es' o 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 Septic; Welly Flood`plam Wetlands WatershedDistrict� j{I rWater/,Sewed L-- _ OWNER: Name Q Address:g� DESCRIPTION OF WORK TO BE PREFORMED: Type or Print Clearly) 1 Phone(IF)625 501 C NTR;4'CT®R Name �Pone h - , - �. - - , Supe.rvisoistCoris ructiont�Lcense_,� �.�-� Expl ®'ate � - - HommptO�vementWLExp icense-%t_ � Date' 4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDINGjPERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ` Total Project Cost: $ 'App FEE: $ 6� Check No.: Receipt No.: NOTE: Persons contracting with unreaWer ntractors do not have mess to the guaranty fund Signature ofyAgent/Owner=x Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL t Public Sewer Tanning/Massage/Body Art Swimming Pools w 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 COMMENTS y HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & DateDriveway Permit DPW Town Engineer: Signature.,. Located 384 Osgood Street �uocatea;2i4,i 44jiviam atreetg i { 4. +rsrv. F...j3 tet_ -.'srYi � 'k � � t!."a., r+.A s�J Ch.'s �,`; ,.{ �, y �. r. � r� •� D Fire�Departmentsignature/dated,�- t ro COMMENTSi_ 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 NU I t5 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) ❑ 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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 oa' 0 Ci) � z z v o 0 D TO. 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ROGER A OVELLE' TTS s_ 55 STANTMORE ROAD Waa r�wykk RH 02089 15 �. 91 i Restride l To: CSSL- 8Cc a InsWatu®n Contractor r Faflure t® possess a current edition of the Massachusetts State Building Code is cause for revocation of this Hcensseo For ®PS Licehsing nformatuon visite www.Mass.Gov/DPS NEXTS-1 OP ID: BS d'°���® CERTIFICATE OF LIABILITY INSURANCE DA 11/09/12 MMIDDNYYY' 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 endorsements). PRODUCERACT Phone: 781-665-2775 McLaughlin Insurance Agency FaX:781-665-0295 828 Lynn Fells Parkway Melrose, MA 02176 John E. McLaughlin Jr. NAME: PHONE FAX A/c No Exit: A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:OneBeacon Insurance Group INSURED Next Step Living, Inc. Mr. Brian Greenfield 21 Drydock Avenue, 2nd Floor Boston, MA 02210 INSURER B: Hartford Insurance Company 19682 INSURER c:A.i.M. Mutual insurance Co. INSURER D: INSURER E: INSURER F: rnvcoar_cc CFRTIFIrtaTF NI IMRFR• 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 LTR TYPE OF INSURANCEkDDLSUBR NSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR 7920005600001 11/11/12 11H1/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $- 2,000,000 GEN'L AGGREGATE LIMIT APPLI ES PER: POLICY X PRO LOC JECT L1A PRODUCTS - COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS X HIREDAUTOS X NON-OWNEDPeoaccidenPER AUTOS 3900012090001 11/11/12 11/11/13 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILYINJURY (Per person) $ BODILY INJURY (Per accident) $ t AMAGE $ A X UMBRELLA LIAB EXCESSLIAB HCLAIMS-MADE OCCUR 7920005610001 11/11/12 11/11/13 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A TO BE ISSUED BY CARRIER 11/11112 11/11/13 WC STATU- 0ER X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 500 000 E.L. DISEASE - POLICY LIMIT $ , A Property 08UUMHX5485 11/11/12 11/11/13 BPP 1,033,89 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Office INFO -01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ale— 11�lu( ' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE r'� 11/12/2012x' 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 John E"McLaughlin Insurance Agency LLP 828 Lynn Fells Parkway Melrose,' MA 02176 CONTACT p�E FAX Ext): (A/C. No): EA/M�CILNo. ADDRESS' PRODUCER _ CUSTOMER ID#. INSUREDS) AFFORDING COVERAGE NAIC A INSURED Next Step Living Inc 21 Drydoc,Ik Avenue Boston, MA 02210 INSURER A: A.I.M. Mutual Insurance Co - 33758 INSURER B- 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 TEAMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ltz TYPE OF INSURANCE POLICY NUMBER POLICY EFF (FPtND/YYYY) POLICY EXP (ea)/DD/TYYY) LIMITS GENERAL LIABILITY EACH OCCURANCE $ ❑COMMERCIAL GENERAL LIABILITY ❑❑CLAIMS (NIDE ❑OCCUR DAMAGE TO RENTED $ PREMISES(E.. occurrence) MED EXP (Any one person) $ PERSONAL S ADV INJURY $ QGENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: PRODUCTS - COMP/OP AGG $ ❑ POLICY ❑ PROUECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (ea accident) $ ❑ANY AUTO BODILY INJURY (per person) $ ALL OWNED AUTOS BODILY INJURY(per accident) $ ❑SC HEW LED AUTOS HIRED AUTOS PROPERTY DAMAGE $ 1per id=) ❑NON -OWNED AUTOS $ E $ ❑UMBRELLA LIAR Q OCCUR EACH OCCURRENCE $ ❑EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ ❑AE TENT ION $ $ WORKERS COMPENSATION AND EMPLOYEES LIABILITY OT TOAY LIIfITS ER ® HC sTATu- ERH- E.L. EACH ACCIDENT $ 500,000 THE PROPRIETOR/PARTNERS/ A EXECUTIVE OFFICERS ARE ® incl ❑ eXCl 702515301201211/11/2012 11/11/2013 E.L. DISEASE -POLICY LIMIT $ 500,000 E. L. DISEASE - EA EMPLOYEE $ 500, 000 LL COMMENTS / DESCRIPTION OF OPERATIONS OR LOCATIONS: WORKERS COMPENSATION COVERAGE APPLIES TO MA EMPLOYEES ONLY CERTIFICATE HOLDER CANCELLATION PROOF OF COVERAGE 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 t L ne t;ominonwealrn ®, j 1"assacnuseas 7 w Type of project (required): Department of Industrial Accidents 1. ED I am a employer with 400 4. ® 1 am a general contractor and I Office of Investigadons I Congress Street, Suite 100 7. ® Remodeling Boston MA Md ®2114-2017 e-www.mass.gov1dia g. ® Demolition Workers' Compensation Insurannce davit: Buff flezrs/Co>rntractolrs/Eleetricia ns/Pflumbers 1��l�flie�nnt Information Meuse Print ILegLbly NaMe(Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave - City/State/Zip: Boston, MA 02210 Phone M (617) 850-9101 Are you an emmployer9 Check the appropriate box- Type of project (required): 1. ED I am a employer with 400 4. ® 1 am a general contractor and I 6. ®1Vew construction employees Mull and/or part-time).` have hired the sub -contractors 2. ® 1 am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees 'these sub -contractors have g. ® Demolition working for me in any capacity. employees and have workers' comp. insurance.t 9. ® wilding addition [lido workers' comp. insurance required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions3. ®I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself..[No workers' comp. right of exemption per MGL 12.[] Roof repairs insurance required.] 1' c. 152, §1(4), and we have no . 13.21 Other Insulation employees. [No workers' comic. insurance reouired.l *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. lContractors 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' comp. policy number. Ian an em player that asIpr'aovdduaag workeos9 compensation i nsmeaanace for my employees. Below is theIp®ducy andjob sue information. Insurance Company Name: A.LM Mutual Insurance Company Policy # or Self -ins. ILic. #: 7025153012012 Expiration Date: 11/11/2013 Job Site Address: City/State/zip: Attach a copy of the workers' compensation policy declaration page (showimmg the policy number and expiration date). ]Failure to secure coverage as required under Section 25A of MGL c. 152 can Head to the imposition of criminal pegnalties 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. Il do hereby certift under the Phone #: that the inonma don provided above is true and d correct Official arise only. Do na®t write in this area, to be completed by city or town ®f ciaaL City or Town. Permit/License # Issuing Authority (circle nine): 1. Board of Health 2. Building Department 3e City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M next step living home of xierrc� made easy This agreement is made by and among �oauaora�,� w PARiiCRAiNIe CONTRACf08 Maty E CratlstOII 92 Sandra Ln Next Step LNng, Inc. ('NSI ) 21 Drydock Avenue V floor North Andover, MA 01845-4614 Boston, MA 92210 Prged ID: P00000103172 Contract ID: 20121129 WORK Site IM 500002099754 1. DESCRIPTION OF WORK TO BE PERFORM NSL will perform or cause to be performed the foilvoirg work on the cusWWs address above, in a professional manner and in acoordaree wills the terms of this Contract including the abased recommerbationsiwork.order describing the work in dehii (the'Workl which are incorporated herein by reference: Daecrlpnllon 4uwft Location Atfk Floor Open B1ov(Ce6ulose 8' . 2132. _ thMgSpace 53,112.72. Install r Themral Barrier Potyiso On Kneewen . _ . 111 UVd Space. 5466.32 Insulate Rin Joist inch 825': Fiberglass 13MV.._. S _ _ ! n9 SPS..._ • 148 N/A. _ 5273:80 . PropaveM 2'_ot 4' 108 Attic $378.00 Vent bats fen to roof flapper ... 1 Attic 5918,00. . Sub Total: $4,361.38 E9Y iElftlency InceMNre 52,000.00. Net Bales Tax Afterincentivo $0.00 Total $2,361.38 2.AP YMENT: CUSTOMER agrees to pay NSL for the work as Mows.- Pdnto* 12M41012 Paye 1 of 7 Paymert#1:5 Z-i:I• -Credk Card or E4seck deposit is due at the time the Work is .Required payment infomration will beouboted overthe phone by a customer service mpresentative.at the tine of scheduling. Deposit is not to exceed 113 of the total retail costs. This contract is not in effect instil Oft deposit is paid by the Customer:.(Note: Mastercard, Visa, and Discover accepisd) Additional Payments and Final Invoice -Additional paymems for Me Work sal alba due upon ccornpte6on of the Work. CusbmerS✓. Date g � j�=1ru 2 Jy it /i�12 JA(�/l/r !A N& Signature 6 Date Narne of NSL Representative . The Toms of -this Agreement are contained on Doth aides of this page Next Stop Living 21 Djdock Avenue 2^dtloor ^ Boston, MA 07110 (8M 8674729 ^ hquirAnesdist8isiftimcorn , www.nextsteplivirginc com Location � -S�,119d�2e 1.41 No.-4� Check #2�/ !?wf� 26258 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $-5jF-- Foundation Permit Fee Other Permit Fee TOTAL 131—ilding Inspector