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HomeMy WebLinkAboutBuilding Permit #036-15 - 946 OSGOOD STREET 7/11/2014 TOWN OF NORTH ANDOVER of NORT►M APPLICATION FOR PLAN EXAMINATION � a Permit NO: Date Received 'Zno•� �,SSICHUSet Date Issued: /� y IMPORTANT: Applicant must complete all items on this page LOCATION 9 1-1 6 Oqc rc J 6V Print PROPERTY OWNER fl 1/I'd ,�0 e. Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial X'Alteration No. of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED I -- C C,i 1i o 'nrl H✓t c>Id- © eVb i VI Identification Please Ty4 or Print Clearly) 80 OWNER: Name: �fj V a/ �� Phone: 1 l �� Address: // �/, CONTRACTOR Name: v✓) k er'�v+)C,�1d ! Phone: 7 T-5a l_ :5 6 Address: ale n d6 Supervisor's Construction License: — 0 5 yo?o'?(0) Exp. Date: / - oZ y c?O/ Home Improvement License: J 4 9 O 8 Exp. Date: �7 / 5- O / �1 ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMAD COST BASED ON$125.00 PER S.F. Total Project Cost :$ 8 O© 1 00 x12.00= Check No.: Rece' No.: Page W4 E 56 , GU P r 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 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 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 signatureldate ,. y 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 Permit Revised 2014 Building Department i 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 i o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass 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) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit L3 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report u Engineering Affidavits for Engineered products NOTE: 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 9' No. l. e7, Date . - TOWN OF NORTH ANDOVER • S�QED yam' • • Certificate of Occupancy $ ` Building/Frame Permit Fee $ Z > n Foundation Permit Fee $ 2i Other Permit Fee $ d TOTAL $ Check# Building Inspector Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ' License: CS-054228 ewb MARK S BUNKER` 6 GLENDALE ST �` HAVERMLL Mk 01832 i Expiratior Commissioner 01/24/2011 t%ORTH Town of t E ndover 0 % LAKE h over, Mass, OCMICMIWICN J�A�R.tTED S u BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ......... v ...... . <-................ ,,,....................._........ BUILDING INSPECTOR al6p Foundation has permission to erect .......................... buildings on ... .....�.... ...... ...................................... Rough to be occupied as ................. .�� t... .... . . : 1.J,.I.G�!�:.......................... 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 ................... ..................... 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. ACT GLASS & ALUMINUM 27 Charles Street, North Andover, MA 01845 Phone: (800) 891-9919 Fax: (978) 686-0022 Email: sales@act4lass.com 44 Ale �uzx - ---------- • A 50F .-2 ,7-6 I -�, 69 1 ) cS I G�.2 �S%0 / 3�1 / ,��7t v e�✓► eX s ��^'✓� ,4COOR vim® CERTIFICATE OF LIABILITY INSURANCE 7���2014m� 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(les)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 Sullivan Insurance & NAME: Sullivan Insurance & Financial, Inc. PHONE (978)372-2790 AICNO:(978)373-2281 487 Groveland Street a RIE ksullivan@sullivanlF.com INSURERS AFFORDING COVERAGE NAIC# Haverhill MA 01830 INSURERA:Preferred Mutual 15024 INSURED INSURER B:Citation Insurance 40274 Bunker Building & Remodel, LLC, DBA: Mark INSURERC:Travelers Indemnity Company 5658 6 Glendale Street INSURER D: INSURER E: Haverhill MA 01830 INSURER F: COVERAGES CERTIFICATE NUMBER-CL147702276 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 VVITH 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. ILR ADOLSUEIR TYPE OF INSURANCE POLICY NUMBER PM/DD/EFF MW ICY EXP TRLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 50,000 A CLAIMS-MADE F_x1 OCCUR CPPO100590009 /5/2014 /5/2015 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 X POLICY PROj F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ 250,000 B ALL OWNED SCHEDULED 140 BODILY INJURY(Per accident) $ AUTOS X AUTOS /3/2014 /3/2015 500,000 X HIRED AUTOS X AUTOS ED Pera�tlentRTY DAMAGE $ 100,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LU\B CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATIONWC STA OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? NIA PJVB-SB61451-2-13 2/27/2013 2/27/2014 (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 I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) General Carpentry Operations CERTIFICATE HOLDER CANCELLATION mark@bunkerbuilding.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA AUTHORIZED REPRESENTATIVE Diane Fraioli/RJG ��x�t.. ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 igninnsi m The aelnp 1 noma nnri Innn ore renicinrorl m2rlra of Arnpn