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HomeMy WebLinkAboutBuilding Permit #264-2017 - 95 GREENE STREET 9/13/2014 BUILDING PERMIT o FNORTH TOWN OANDOVER f (� APPLICATION FOR PLAN EXAMINATION `'f +L Permit N0: Date Received '� °, Date Issued: �9SSgcNus��fi� I ORTANT: Applicant must complete all items on this page LOCATION 95 Greene Street Print PROPERTY OWNER Anthony Moreschi Print MAP NO: _PARCEL:7v ZONING DISTRICT: Historic District yesno 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 ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer crawlspace insulation r Identification Please Type or Print Clearly) OWNER: Name: Anthony Moreschi Phone: 202-329-8702 Address: 95 Greene St. North Andover, MA 01845 CONTRACTOR NameJoseph A Ryan, Merrimack Valley Insulation Phone: 978-408-7832 Address: 23A Sullivan Rd Billerica, MA 01862 Supervisor's Construction License: cs-075541 Exp. Date: 02/04/2017 Home Improvement License: 180506 Exp. Date: 11/24/2016 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2,788.47 FEE: $ 3�j '— Check No.: I F77— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access pthe uaranty fund Signature of Agent/Owner see attached Signature of contractor - __ 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 Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m 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& nate Driveway Permit DP'6W Town Engineer: Signature: Located 384 Osgood Street FIRE,DERARTMENT - Temp Du_mpster onsite :yes, no Lobated at.124,Main Street Fire,Department signature/date 6, 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 dr®p requires approval of Electrical Inspector yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and - P 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 I 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 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 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 46 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 ff J No. L^tr_ c! 7 Date . - TOWN OF NORTH ANDOVER" �W • Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 4t ' �� f' % / Building Inspector/ F_ , NORTH - : F q 6 : ve" - O - oh ver, Mass, Kbw A- COCKICKt WICK y7' 7q A�RArIO 'k?, S U BOARD OF HEALTH Food/Kitchen i T,4 LD Septic System • THIS CERTIFIES THAT .....PERN '�S • BUILDING INSPECTOR ... ........... ........... ...... ................. .............................. ..�5 6i '.%. Foundation has permission to erect buildings on ...... • ............. . ............................. '.................................................... Rough to be occupied as ......cr-4�... ....., . . .. Chimney provided that the person accepting this shall in eve respect conform to the terms of the application� pp 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 CONS 10 /7 Rough Service .. ..... ... ...... .. .. .......... ... ....... Final BUILDIN NSPECT0R 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. ,A 4155 Paderetmf000lQd6i0 MOM Ra�mattoa Ito tttHO \�I/. 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S90.00 Toms: AT" P'lOgfAm ft=n iv0: $211"AG tuornor Tobi: watna�rvawpvaxea .oot�eat�+rxa�ovaevao�aaat�oavrmaubov "%k H n ftd Tan&87MG9 Dolluta $810 87 mea no wool soul ARTI IRMN& SPAM r � , faeaaraa �►oaW ` e�or ilk 30 arts as Kvilc Guys f'h erre 6.4),ie w 2 t�v e✓e Tt�erre `1}p �/r 6 c A�RCJABolw'W /4.�, CASE# Y � SIDING &CBI VINYL/ALUM I ASB BRIC „c C ROOF COLOR'6r Qu/w VENTS BATH FLAPPER x/�i RIDG ROOF x JJOGABLE x_41 SIZES '�� ' OK FOR WORK Y/N SOFFIT: NONE OOD. ALUM/VINYL DEPTH r�COLOR Ill iJ- STYLE � 12. w rte,t> �o a✓•$ � �✓vj=4� -_ �V___._____ Y _._._ wov- L ---� c !Z. 4J 9. �� G(, aav' 19'!�✓J 1212,. �+'�� = � f$. iii t fiYc�v. s ----�N�'_.1��c�,�/�`e._._�.S.E��__ ��%ts�►�t�e..��..��..._w_e,c�:��Qr� �_.._G�..l� ._.___l.La.T._� G�e.�`j yljl.S.�P��f_sc,_.._.j�-�.�4,s•_ -- - _ _.� __ _ dam ��_ iso' �rN L�tn7_,._/�✓i.�,� I =FLAT =KNEEWALL f-�WALLS DAIR SEALING (HADD VENTS SLOPE =KW FLOOR f7KW SLOPE f--I S1LLS f7 Q MAKE ACCESS ❑EXISTING ACCESS i RISE60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6336 ENGINEERING www.PJSEengineering.com OWNER AUTHORIZATION FORM I Anthony Moreschi (Owner's Name) owner of the property located at: 95 Greene Street (Property Address) North Andover, MA 01845 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. s ignature Date E(DEOVE D MAY 2 7 2016 J The Comuion-wealth Qf Massachusetts Department of Industrial Accidents Office of T_-yestigations 600 Washington St. Boston,YIRk 02111 vvv.,:t. -ass.naz.%dia Worker's Compensation Bisurance Mdairit: Builders/Con actors!"-l'lectiicians/Plumbers Application suforniation—Please Print Legibly '4a�me{BusinessiOraanzza�on,rndiJiduai/Oi�•ner:L � �'Ac-e,1�-ll _11kx:tln�luiu � � Address: a-2, A cSu. bV1a t,,' 2-,�,. Ci#v/S#ateiGip: J 1 J�r I cA l ft:� C;i khz- Phone E i Are you an employer`' Are you the homeowner? Check the appropriate nuanber: ` 1. I am an employer with employees(full andfor part time. 3_ i ani a sole proprietor or partnership&ha.a no employ ees rrorkinE for me in any capacity- { = t . 3. F aril a hoiFieormer doing rill..rork n;:°seIf. (`+o workers compensation insurance required.) j I am a geasral Cr3Rtr 3CrOr t L have hired the situ-contr actors listed on the attached sheet. � IThese contractor have workers comp.i-nsurance and!have at-Lached a cony of their ins.) Vti a are a corporation and its officers have exercised their right of exemption per MC-7. lo-s l i; 2nd Yve have no employees.(fli-o workers comp.instiraince required.) t i i u _ale applicant ti.at cher'—'s Eos=i must also iiil--,ut the scurion below showing'their workers'comp.policy information. ( Hom-Co ne%SYio Suomit Yhlic rv�tu.lvd lnUnCttlttIr_ii ty ''i a _• x.__ c_tu�- .i.:I'."..'.t:..�.. I arm ut.c.__di:r8:a u:t:ti:a:x iu72've:-- wiunti:ce mit a dat'1tlildlcazino=such. I i i o Contractors that check thio box mus_`a—,meh:tit additional sheetshowin-E!he un-me of the Sub- ',MccL 2-d tIICIr�YOr�'2rs' l t compensation pour,information. Type of project(required): ChecIt appropriate= t s_ New Construction Remodel e�n_Z S._Demofil.�� R 9- Buildincs aadditionf 10_ Electric: 111. Plumb.U. Roof 1-37 2 Cather 1_ TSa_La 6., lam an emplo_er that is providing workers'compensation insurance for my cm131oyees. Below is the ooliq&job sip info. Insnrance company Name: PoLcy r or seIf-ins.Lie.= Expiration Bate: _ mob Site Address' Attach a copy o:Frarkees compensation policy deckaratior.page(sho:ring tlae policy number aril expiration date. Failarn,to sa-m-r.,covera as reGnlrad wilder Section 25 of NTT c_ I5?can ie--d to the i-mos-I'm ofCriiii 2l oclnities of a fiiie u1 to Si 500.00 aridior one tear iinpriso:lmGrs_,us well as civil penalties in the fOialL Oi a 3TOF WORK ORDER a_-id L c tie of tip to 3250.00 a dy against-the violation. Be advised that a cop, of this statement may be forwarded i0 die OsA:ce of in-vestigations Of the DI for ins urance covera_e verification. do herebv c„-i_i r.nder:l_e pains d penal-Lits rifparju^r:hat the inf t anon pro i-ided above is true and correct 'Date: Official tcial use on.! : Do not utile in tris area,to be completed by.city or tovin officiaL � 1 PviTit: T '.nngn— 4 issuing, A uil-�.ority (checko:7_4 L 1._13joard of 1-imith _ 3uildinz Dept. 3- Cit,.,ffn.:n Ciera. 4._E'ectrical lillsp. 5. Plumb cel:Gcs 6 Me- 1 Contact Person: E print; Phone j CERTIFICATE OF LIABILITY INSURANCE DA, DIYYYI) 6!/13/21312016 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). ODUCER CONTACT NAME: tomatic Data Processing Insurance Agency,Inc PHONE FAX 012 Boulevard ac No Ext: ac No): E-MaL seland,NJ 07068 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:5Star V3 AAIC American Alternative Insuran iURED Merrimack Valley Insulation Corp INSURER B: 23a Sullivan Rd INSURER C: North Billerica, MA 01862 INSURER D: INSURER E: INSURER F: )VERAGES CERTIFICATE NUMBER: REVISION NUMBER: PHIS 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 'ERTIFICATE 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. TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP SR POLICY NUMBER MMIDD MIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DA COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY F1 PRO- LOC $ JE cT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED tid P BODILY INJURY eraccen AUTOS AUTOS ( ) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE P $ AUTOS er accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED T RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECURVE 9WC749118 6/1812016 611812017 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 .SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) _RTIFICATE 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 ©1988-2010 ACORD CORPORATION. All rights reserved. CORD 25(2010105) The ACORD name and logo are registered marks of ACORD -cis• J!i` .�•- _ - i -_ Office ofConsL unerAfl-airs and Business Regulation =' i0 Park Plaza-Suite i 170 Boston;Massachu setts 0-9116 Home tn,provelnent Con�actorRegistration Registrafion: 130506 MERRIUACK VA t l Type: Corpora5on Lam'INSUILATION GARP Expiration: 19124!2046 26'.524 JOSEPH RYAN 23 A SULUVAN RD - -- - _. ----- - - BILLERICA. ---- SILLER€GA, 1C1A 01862 Update Address and return card.,-lark reason for chanbt __.. _ :-•z ;t Address Renewal _ p Y --Lost,Card - - I:m la meat Or6ce of Consumer_%frairs SBnsi � :::•r 1. iL7PROVi21S;EldT CO.iQucueTORss I.c�Uon License or r oi�tion valid for individul usconjv T,sgistrztion iEOSyS before t8e Mpirntion date Iffound return:to: xpi ation :1c?G p76 TyPz Office of Consumer-•';sirs and Rusinm Reguinuon � - orportion iRPact1pt�_gureSi;rC MERRi iACKVALLEY Ir2SULAllpT.CORP b'OSCOn.MU 0213.1 JOSEPH RY,sid 23 A SULUVA-14 RD SILLERICA,fIA L11862 rj -_ f t J .i Fndcry=rt'cian• ` tiotvatid:�itllontsignature I � f xicSS''1ldSE-j-Vis_• Of ; L!=e se:CS-07S541 JOSEPH ARYATJr `` r 200 Mn.Pat1 fir. pt 2(33 - , 4 muffeld KA. 0040 - 0210412o17 I