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HomeMy WebLinkAboutBuilding Permit #423-2017 - 95 LYONS WAY 10/9/2016 Location No. !. ' Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ..-� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C ` _ Check# `y Building Inspector ,� `L �C L� r10RTH BUILDING PERMIT Q�,+SL'ED ,6'9•b 7 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � z yy Date Received 0— �o Permit No#: �� � I � � � � �RA7eD'pP •(`� gSSacHus�� Date Issued: 1 0- 1 9 " 90 / ENIPORTANT:Applicant must complete all items on this page -Wlntr - pR®PERTYe OWNERS U C . rat YearSttructre➢ es IVIOk—JAL RCEL_� , ZONIN DIST{RI�CT Histori D�Stnct yest nod , Machine,Lh-ft Village y47 not, TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building One family �ddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other iSeptic . ; � oLW_ dpinNada d'Dtsncta _ DESCRIPTION OF WORK TO BE PERFORMED: x Identification- Please Type or Print Clearly OWNER: Name: 66o onil L Phone: Address: L onS WYW i.+ > n `aw+i - 1 % t'i( - t Cp....c yc� .•y5",�i '{ .� L f 1-'tf.l,l 'yX q..� f i y.. F .. 1 4{+5•PI 1 .++.t+. [ 7 Y �La• e 4 a J rn ame //r! 1 * �FSupervisors' tonsruct�onL�censec r w ZP, i1'12Z u y z 3^ : i W i - r` --; ` x IDate --l7 .... . .. ... ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ l r� FEE: $ IA,O Check No.: %��7� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to h uar fund Signature of Agent/Qwner Signature of contractor 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products require sign off from Fire prior to issuance of Bldg Permit Department NOTE: All dumpster permits req g p Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 ❑ 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ l Tobacco Saes ❑ _ 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 4 Phnrving Board Decision: Comments r Conservation Decision: Comments Water & Sewer COnneCtion/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE *xL,il,rw.g tesDtlD-:.e`aFpE��tpPa1a,-}#A!i R�4�Ts. yME,�rxicNTI a�"%„+iu`j.3�Me,�m,}'p.2.p.-,���., ”. .�^,"+°`er* .,�r`}�, .{ ',";i ��,F'-,t,fR,.{y�.(a,yz*�•_Located ocated;` 38n�..4 o t�Osgood sgood Stree-;t umpsteron,site,.)yes --� 24areet Firertmentsignaue3* r • * M'!.�� ,.,h} + . w.... :a_ ... . r.. ,4„�,ry .��+y �S s q��'�'.��._y...`.�+`a.,k'"""".,„. e�*�'�Y_+c..S—�'.'�"`i�,.: • '4 COMM * COMM Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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) I ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 it NORTFf ' At, ve" - 0 . . �^ No. ® :, h " * ver, Mass, �/�.� COCMICKlWKK � 7,9s J�ATEO ►'Pa,�,�� U BOARD OF HEALTH Food/Kitchen . T P E RM IT Septic System BUILDING INSPECTOR 1 THIS CERTIFIES THAT .................s I . � .. i .�.. ... .............................. �•.' Foundation has permission to erect .............. buildings on ...... •• •• ••••••• �••.. p Rough ............ 0 be occupied as o.c*. D�.*............. O .... ................. 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ANUS Rough Service ..... Final BUILDING IN§WCTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough - Display in a Conspicuous Place on the Premises — Do Not Remove Final FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. Commonwealth of Massachusetts Sheet Metal Permit Date : Permit# Estimated Job Cost: �`�, , dy Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# .Applicant License# Business Information: Property Owner/Job Location Information: Name: �cLC7 00? _ G Name: Street:_ P() 3-7-Z- Street: Lroa� City/Town: City/Town: Telephone: �$`� - Telephone: &6 -cog ZT YSO Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family__Y_ Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. / over 35,000 cu. ft. Sheet metal work to be completed: New Work: / Renovation: HVAC V Metal Roofing Kitchen Exhaust System Chimney mney/Vents Provide brief description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑ If you have checked Yes,indicate the pe of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: BY Master Title ❑ Master-Restricted CityrTown ❑Journeyperson Signature of Licensee. Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpi Inspector Signature of Permit Approval 2-Ae wealth aflH=ach=effY DeFmftqzt of ridAcdLr eb" w - - 600 Wr=Yxgfbu Sftet ' BosbY4 H4 02M ' wwfvgavl�ra Workers'"Compensaiian hMrgn=Affiftft B'tdfConiradorsfeiiaas/I�Im�bers A.n t Infor -afiou Please Print Name G -Ari&mw. ��• /� 372 - ArE�ab employer?tick 2pp" griafeboz: Typeof*ject(regs. L Iam.a w� 4:�iamage�al aodl cmftacfm �IO� * hot baedfe�s-� h- Q1�Tcw 2Q I a Ic eepsiir. IisbAcmilm-adacbedsheet 7:[]Rmo&hgg sbfp and have no=play= � Have g. Q D RRIM wor�g,far mem and boyo wow' any.�y No waciap'coin-insurance CM3P• —- ---rupirC&I - S.[].We=a caqiodic.mmdifs 10-QEDrepass aradditions - 3_ i am a hm=owncr ciaiag all work of rm=have mmmim&f3ek, I1-0 Phm�bmgropa;rs or additiaa�s [go wadmm' - hof a Per MGZ bmmmm I t A 152,§1(41 and:wehaveno =Pby=r-[No wow' 13.E1 Ofbe� cm1p-hmmm=m�j ��e?���r.5xlabazala�tala�SIlo�fcearr.Grxibeiows�gti��ead�" vow -- t8aaraaeaca�¢ho sn�Y�srtm�mgtfiey�edo®gsIland$ua}�so�dem �stsnbmita�wgsor�. ¢�cl�fl�b�m� salabaE�gSmaameaf�sse�- smdst�'w�a�}�se�3� - =--IUYxs waame camp paEepm _ Y I am an euspTrryer isprovu?ingtQarkers'romperLsation ussmmrcefor ruy ererployees Belowis Elie po&7wd job site aaforas�ion. _ ' Q^ Pohcy#or Self-im Lac.t (7 j` 1.)96C7 lob ftAddre= fyi'�.S Affieh a copy of fiie Workme compemmffoapoltcy dedmmfm FRP(Owv&g Me policy nn►nber aad e*4h7 ion dais}. Fazhre;ta somm mveaagc ns reqakzdmodee S=dm2.5AofMUE c;152caalcad tb dm ef�-pmaY=of r. furs mp to$1500.00 snd/ar onn--ycm kgdsamnmk as veil as didp=bim inlhe fisrm ofa STOP WORT;ORDER.aad a fma ofup to$250.00 a day againdlgviabhm Be advisedtird a copyoffbis sia&zeofmagl a tQ ibr Ofce of hmmdvdm o£tbe,DIA fm vedfiaficm. Ido hmby cert► tare mrdpe<ra res Of pedm y that the urfomdimF%vhw abmfr true= correct Siete y' Dara: — O,�}•rrial use only. Do not ivrHe in ift area fa be marplefed by cfty or town a,f fdaL City or Town: Pce�e IssrmrgAxffio&T(c rde nna): L•Board of HwI& 2.BmZdmg DeparCx_ t 3.(Sct gTowu Qerk 4.MectdcRI Iagmctnr I PhmbIDg bzPocfnr fi.Ofher Corli�ct P�soa: Phone ir. - formation and Inst ue ions Massachnsctts c,XalLm chapter 352 mqm= Ucompenssfion' ' P�to this statudrti an d as"_carry PesaaMin seavice of �y capress or impliA Cal or wrifte Aa egloper is dafined.as"an P assoccoqwahoa or° deceasca=Plum or the of eflisaJamie�pa , and incli mg M Eftywm rfac rxeave�or itasf of sa individual, s or other Itgat cry,cmP1aY of tlae GW=of a dwelling hoose leaving not MOM$�$ apat'�S and who resides , dwrniug bause of anatl=who employs pe:soms to do or ICPBr wow oa sari.dwcIrmg}pause or on the grounds or bm7diag filtOtO shall not because of sash employmcrtbe deemtd to be an euzploy=" MGL rfiaptc,152. §?SC(6)also std#hat"��date or Ior�I ling icy shaIl witi�hold t3xe issuanra or renewal of s Iicetise or permit to operate a business or to construct lstn7dings m ffie cmmaouwealtll for ung appfieant who has not produced acceptable evidence of compliance with the insurance 1r��-FhaIl AddiiionaIly,MGL ehaPt=152,§25C(7)states`2Tei$ux the cowwealth nor any of its polmcai sabdivisioas of he workunil==Pt Oz a wdcnce of compliance withlIc ins�ncd e�xr ifn arty cow f� P a r,goimme� ofthis chBptCrhavobrmprmcnmd.tu fm cumftB.mg 9- A PPficards enation a$tdavit completely,by cbexJmg ihr boxes that apply to your sin�if Please tIli out tlse worms' s vxh thea c= fieate(s)Gf $raa tbd nssazY: Ply sub-ccim(s) s).address(�s)mad pbame Pbce()along dna etnploy�s insormce. Lani 11ab*CompanucS(�or dLiabdiCygarmeashm(I,ZP) rocmobcm�p��=� to�y.W�•� n, -ar, IfmiLI.CorI�.Pdoeshave cmFloye s•aPolicyis mquked- Br.advised Sd tics affidavztmaybe oto the Degas of Ane {,�cam of - Also be care to sign.and date the affidavit. The affidava sliuuld for the or lircrose is being�not the Depar�ca2 of be=t ed to the city cr fawnfattbe appHcsfi n P m obtain a ' Iz3da&.1 Aceidr�s_ Shouldyou.have any T=gtiams=Zmdmg law or if yon an rcgm atth Icy,please call the Depaifimertt t;=amber lis6`dbeiow Self4n� compmf= co should a tbeff n pb =If-i==m3Oe license mmbea on the appivptiate Ti - City or Towp.Offidab Phase be sore that tlsc affidavit is complrtc-and primed Icgibly. The:Depaztrncnt has prov�ddd a SPacc at the botir�a P of the a3avit for you to fill out in the evcot the Office of E�tvestigafions has to cordact you regg the a mtmbcc In add¢ion,an app3icanf bd=sod as refescocc Please bd sore fD fr7lmthe pe�lie�se manbrx which vel affidavit indicating�� in need,only submit omp Iz any g�ffiy� that const submit m "alldocafloas ia (city or o ' ffi nwc§,sm y)and under-Job Site Ad h=e Flu ant sbon]d wry P �` - � town be iD� the or may P army. �y fnwn):'A copy of the af3 davit that has hada offi�Y , - must be�=G-at cacti agpHcznt s prof t hd a vagi wait is ou file fm P�a }i=nses. A r, a$�aft a license or to basm'ess or owe ial aeoimze year:�i hraz a 3�owner ar ciiizan is ohtai�g Peon not rclaiEd any (ie~a dog Iicease.pe rtto bumleaves ctc_)saidpco=is NOT Mjpirodto complete Ibis affidavit: The Offfix of Invesfigatams would lkC to bas=k You in advm=for yom coop=ton.and sbouldyouu have:any T=fiaus, pleas,do not hMihte to give vs a caIl. The Dm's, ,t k?hond'amd fax mnnbes: VVTW3i�S3 SMA€ III Fax#617-727-77* Revise,1122-06 A� CERTIFICATE OF LIABILITY INSURANCE F �� io°6"' 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 terns 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 NAME- CostelloCONTACT-MMily Costello Insurance Agency, Inc. PHONE (978)374-6352 FAx No,(97a)521-5127 2 S. Kimball St. ADDRESSecostello@costelloinsurance.COm PO BOX 5248 1 AFFORDING COVERAGE MAIC A Bradford >6 01835 INSURERA:Sentinel Insurance Co. LTD 11000 INSURED msuRERBSartford ACC & Indemait3r Co. 22357 Duct Works Engineering, Inc INsuRERCAartford Insurance gyoW 00914 Po Bos 372 INSURERD: INSURER E: Burlington M A 01803 F: COVERAGES CERTIFICATE NUMBER:CL1671200622 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. ILSR AWL SUSH TYPE OF INSURANCE POLICY NUMBER MMID EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO A CLAIMS-MADEF0 OCCUR PRE E R occurrenosi $ 1,000,000 OSSBMM752 7/28/2016 7/28/2017 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBIBIN D SINGLE LIMIT S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED $ SCHEDULED 08URCAX914S 7/28/2016 7/28/2017 BODILY INJURY(Peracaderd) $ AUTOS AUTOS % NON-OWNED PROPERTY R PEERd DAMAGE S HIRED AUTOS AUTOS kmk 5 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,000 C EXCESS LIAR CLAIMS-ME AGGREGATE $ 2,000,000 DED I$I RETENTIONS 10,000 08 SBA NW1752 7/28/2016 7/28/2017 S WORKERS COMPENSATIONOTH AND EMPLOYERS'UABIUTY YIN $ STATUTE -R ANY PROPRIETORIPARTNERIEXECUTIVE NIA A EL EACH ACCIDENT $ 500,000 C (Mandatory In EXCLUDED? N❑ EL DISEASE-EA EMPLOY $ 500 000 (Mandatory in NH) 081iSCCT8122 7/28/2016 7/28/2017 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 500.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddNionM Remarks Sdfe W%may be adaehed ff more apace is required) CERTIFICATE 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 Emily Costello/HOYECl '; ©1988 2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marlm of ACORD INS025=4mi S CHUSETTSS DRIVER'S LICENSE-- � 40. END NEdS5469315i1�`� 7�' + REST 1s soc M 1s Rct�6�0 i 'NONE: a 7 a v e 8 RUTHVEN AVE"; x jj BURLINGTON MA 01803-0349 F t s 0D 12.122014 Rev 07.15.2009 f� COMMONWEALTH OFMO OHUSETTS BOARD©7" SHEE 1`Il>!>c AL WORKf 7 ISSUES IHE fOLLOWING LICI=I�SES Ii ASTER UNRESTRICTED JOHN� TREMBLAY &;I~t 'TWVEN AYI~' .BURLING' ivlA 01803+1 's 2556 '0/2812097 2216 ......:. ..:.