Loading...
HomeMy WebLinkAboutBuilding Permit #380-2017 - Exception 10/11/2016 �10wscowvktso NORT11 BUILDING PERMIT (Lop) TOWN OF NORTH ANDOVER p - APPLICATION FOR PLAN EXAMINATION ~ n��cE 7K ley Permit No#: Date Received �C)�L06 �4q�R�reu �sSgCHU Date Issued: 10/f t 4;-0/ IMPORTANT:Applicant must complete all items on this page LOCATION Print / PROPERTY OWNER §JP 2 u)t n►c+c L- 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` flew Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r77r �S V 'epttcWell� Floodpairn etlands 01 tershe11 N1 . dlt®istct ater/Sewer, , , fry . ;. DESCRIPTION OF WORK TO BE PERFORMED: hex/-. (1hen (, .2d xyo f tom. U/ i elevo 4 /7d o 2I•�S J-�P wf/n,z ap 7 /alb//4 17&r, Re,ln ale-W S /0 entification- Please Type or Print Clearly OWNER: Name: /, �'2R��»�e �/1".19 Phone: Address: /„S� /JK�► }� f f- �v�-a % " Contractor ame- �r� 7-&( aG... U"-sni Aa hone: -7 Email: de/7n e - c Address: y7� I ( dy�v�, l�i� O/ Ta/ Supervisor's Construction License: Q'(0 O Exp. Date: /O�7 / Home Improvement License: /(o�9�.,7- Exp. Date: t /7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 24n?, tt a FEE: $ Check No.: 2; )L 7)-- Receipt No.: Lo �! NOTE: Persons contracting with unregistered contractors do not have access toAP 9,zwranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped {Tans ❑ 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 e U FORM /LANNING 8 DEVELOPMENT Reviewed On Signature_ V& COMMENTS '" P /CONSERVATION Reviewed on Ob Signature qL-,t COMMENTS -A W EALe e TM Reviewed on Si nat 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 f tt.' t t l t ". , � `',':,�'""°5 i;,,..., .�'�'a9�,"""`,,.-Y'Y'-` .....•;R. FIREDEPRTtENT rnDumpster,onsiteyesr, �>` �-u. tn, ° - — - �Lo ted at 1,24 Main tree., Fide Depaw.-n t igna�tur�e% '" rC©MMENT4Sa 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.$10041000 fine NOTES and DATA.-- (For department use) k/7 CI Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 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 s Location 3/S 7 v.Cn/P ��{� 57 No. 0/-7 Date /C • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $o� 'r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# " = ,� Building Inspector TPS +��� NORT11 q Town of ? _ ... aAndover No. _ h soh ver, Mass, / p I / P 0/ b cocN�c«ew�cw 1' p°OATEN ►'P�'��(y s u BOARD OF HEALTH PERMI. Food/Kitchen LD Septic System THIS CERTIFIES THAT �L�. 4 A t 0 N fowotT. l BUILDING INSPECTOR ... has permission to erect .......................... buildings on ......��.r!..�.!!!!1!�..........�',Q,I�i�,Q........ Foundation Rough to be occupied as A(P ......�e.'�.�..T....... .ENT .............�n .. .. ................. ..�......... ................. Chimney eY 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 TARTS Rough ................... ..... Service .. .... .. Final BUILDING INSPECTO. R 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanuingiMassage/Sody Art ❑ Swimmi-ng fools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM /LANNIMG DEVELOPMENT Reviewed On Sig nature— COMMENTS /CONSERVATION Reviewed on Signature 1/0 COMMENTS ` (:L4 J EALTH Reviewed on � COMMENTS � Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 5 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer C®nnectionlsignature& nate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPAR�TEIVT' T,�em'pD�umpsfer oriisite� ;yes Lo"cate`d at 1241MamSt�eet C.®IVIIVIENT�S" � Y : i1"ir�,�a���` `,� �_- ' ,r;� •t __ `� A Dirmensi®n 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.$10041000 fine NOTES and DATA-- (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Buiiding Permit Revised 2014. 6'%8'handing banners(8)total SULLIVAN ems. =Drape total 190'of drape BUILDING P;5-'k 8't6tem with Pla§Yna screen PARKING LOT MAE e _ i "Ali �<� by .+� �■ ,,,:, kms'^ I ,��. temrlg'renl rz', ib.e caai,es . n w Geerator ., Uradek 1 r ,oeb' - ConnettOr m ; r 10'ie' 3y } oee 4' a= catering t� t� Cbnnettbt LH Li u yit hEh I 1 SWIGULLOLL bil a :#�t'S-,. ""�� q �1� a,��.> F 'U'r4't•. .;3�`tF sa ROAD-VALET Parking Lot GR 20' x 40' 1 ' 6" catering MY 4" 2" 1 ' 4' 211 Oil Sullivan 13 , 1 1 ' 60' x131 ' 7„ 1 , T 40 15' x 25' connections 41 ' x98' B C 0 M� J W � Y L Entrance Pathway E f The Conunonwealth of Alassaehusetts Department of Industrial Accidents i � 1 Congress Street,Suite 100 ;rt Boston,MA 02114-2017 www."wss.goV1 a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lellibly Nal'l'le (Business/Orsanizatioir/lndividual):Peterson Party Center Address:36 Cabot Rd City/State/Zip;Woburn,Ma phone 4:781-729-4000 Are you an employer?Cheek the appropriate box: Type of project(required): 1.rV_1[am a employer with 20 employees(full and/or part-time).* T Q New Construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 3.o I am a homeowner doing all work myself[No workers'camp.insurance required.]t 9. Q Demolition &.[]1 am a homeowner and will be hirins contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11, Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance,t 13.❑Roof repairs h.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.BOtherTemporary Tent 152,§I(4),and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box#]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. +Contractor,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. I am an employer that is providinar workers'compensation insurance for my employees. ,Below is the policy and job site it formation. Insurance Company Name:A I M Mutual Ins Co Policy#or Self-ins, Lic.#:WMZ8008006586 Expiration Date:10/9/16 Job Site Address: lJi7d1f�t�''(� �i� Ci IStatelZi , ii _-..................__..__.__.-Attach a copy of the workers' compensation_.policy_declaration_p.age._(s.h.ovv�ng..ihe pnlic�-..nu.mber..<nnd-expiration date),-- Failure ate),_Failure to secure coverage as required under MGL c. 1.52,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herehy certify under the p whs and penalties of perjury that the iriorrrurtion provided above is4trueil c rreet Si nature: Date: AQ �4s Phone#:781-729-4000 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: phone 4: �I ATE ,aco CERTIFICATE OF LIABILITY INSURANCEF9/26/2016 D /DDIY 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 Michael Bonacorso NAME: Bonacorso Insurance Agency, Inc. PHONE (781)937-3200 FAX No:(781)937-3202 10 Cedar Street E-MAIL ADDRESS:michael@bonacorsoins.com Unit # 32 INSURERS AFFORDING COVERAGE NAIC# Woburn MA 01801 INSURERA-Acadia Insurance Co. INSURED INSURERBAIM Mutual Insurance CO. PPC EVENT SERVICES INC. INSURERC: PETERSON PARTY CENTER-TABLE TOPPERS OF NEWTON INSURER D: 36 Cabot Road INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER:PPC 2016 / 2017 Master 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE X TO RENTED 250,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE 7 OCCUR PA5061026-14 10/9/2016 10/9/2017 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 POLICYX PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED HAA 5063173 14 10/9/2016 10/9/2017 BODILY INJURY(Per accident) $ AUTOS X AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Ulm/Ulm $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ UP_ 5173416 10/9/2016 10/9/2017 $ B WORKERS COMPENSATIONX WC STATU- 6TH- AND EMPLOYERS'LIABILITY TER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA 10/9/2016 10/9/2017 (Mandatory in NH) Z8008006586 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 I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space 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 Michael J. Bonacorso ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSD25 oninnsi m Tha Arnpn name nnA Innn nra ranicfararl mnrtrc of Ar'npn Massachusetts - Department of Public Safety r Board of Building Regulations and Standards License: CS-060219 Mark Traina 33 Hanford Road.: Stoneham MA OA280 , Expiration Commissioner 04/27/2017