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HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (21) BUILDING i BUILDING PERMIT itkOQ TOWN OF NORTH ANDOVER APPLICATION FOR PLAID EXAMINATION n Permit laioff. C V / ita eReceived7 §Arlo dm....q. � iCN11`�( Date Issued, l`� 1M 'U Z' 'AI S. Applicant must cot .Tete SII items o this a e 4 LOCATION R -0C� i-ti t f PROPERTY OWNER �,� x Pint tots Year,Strut#urs yes no MAP PARCEL: ; NINE DISTFICT. Istorc DI #Jict yes no Machine Shop Villadb, ' jes no I _ _ p y TYPE } iMPRt��dEMEiTResidential t D U .............. ' Non- Residential ........____ T_. . M _ . New Building . 7 One family � i "..,'Addition E Two or more family E Industrial Alteration N o. of units' i Commercial E Repair, replacement ;1 Assessory Bldg Others: Other Demolition Septic CI Well Floodplain 0 Wetlands 0 Watershed District Water/Sewer i __.._ .DESCRIPTION OF WORK TO BE PERFORMED: . .............'-�.X � +__ eGf� cc>�.._.. ?_. � IJ I �ja ........ � _ _. Identification- Please 7 e or Print Cteari OWNER: Name: Phone: .Address: Contractor Name: r Address:: 2 t Sk C.t, � r-_ MA- ©Z . N Supervisor's Construction License_ : Exp. Date'. w . Hone Improvement License: Exp. Date: ARCHITECT/ENGINEER C` 6!Z-) Y�� Phone: ��$ '��C�� �S�`3 2- Address: Reg. No,_ EEE S HEDULE-BULDING PERMIT:S12.00 PER aSldoO.ao of rHE roTAL ESTIMATED DGSTBASED ON$120.00 PER S.F. Total Project Cost, �3 � (�749 _ „_FEE: Check No.: Receipt o,: - 6�?77 7v NOTE.E. .t'er:sons contracting with unregistered contractors do not have access t the gnarano fund ionatUrellr nt/O ner Sianature �a act 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 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 ❑ 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) ❑ 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 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 El. Certified Plot Plan ❑ Stamped Plans ❑ _T_YPE_OE)-SEEWERA.GE_D.I.SPO.SAL_ Public Sewer ❑ Swiing Pools ElTanning/Massage/Body Art ❑ mm 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 s T 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 signature/date COMMENTS i —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) i ❑ Notified for pickup Call Email Date Time Contact Name --------..._.._...------ ............... --- ----- _.�.- -–--..`._ -------— Doc.Building Permit Revised 2014 .Location (9 �ra No. �/•�—/ Date . - TOWN OF NORTH ANDOVER • �--���rte' � . Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# V building Inspector Enter construction cost for fee cal - North Andover Fee Cakulaf/on Construction Cost 21 ,000.00 m $ - $ 252.00 Plumbing Fee $ 31.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 31.50 Total fees collected $ 415.00 29 North Cross Road 367-14 on 10/18/2013 Master Bath Remodel -VI Enter construction cost for fee cal - North Andover Fee Caku/atlon Construction Cost $ 434,875.00 m $ - $ 5,218.50 Plumbing Fee $ 652.31 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 652.3.1 Total fees collected $ 6,623.13 1160 Great Pond Road 048-15 on 7/11/2014 24x30 Storage Building it �ORT� Town ofAndover .. : � O - �' 0 No. * t o 4h ver, Mass, coc Nlc NtwtCK �1. x,45 RATEC) f,1P �S U BOARD OF HEALTH Food/Kitchen PEIRMIT T Septic System LD Z��THIS CERTIFIES THAT ` �,,,,,,,,,,,,,,,,, ,,, ,,, ,,,,, ,,,,,, ,, BUILDING INSPECTOR has permission to erect .......................... buildings on - 6 D... l?: `. �...U.� Foundation � Rough to be occupied as IV�lee �� c, _-c .� �G�— �� //6�v.��/lE A 6_e_fE� �i � u n p� ..................................... .... ........ ......:..:...........................� ..... ..� l'rr; 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 CONSTRUCTI STARTS Rough Service ............ a .................................................... 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 i Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. I a ."te r -W./.,:�mff-0) LANDSCAPE & CONSTRUCTIO CO. INC.�- 21 Malbone Street Lakeville, MA 02347 P. (508) 823-6699 F. (508) 823-7502 July 11, 2014 Mr. Gerald Brown —Inspector of Buildings Town of North Andover, MA 1.600 Osgood St. North Andover, MA 01845 Dear Mr. Brown, It was nice meeting with you yesterday. I am writing on company letterhead to provide you with the information as you requested. Following are the items you requested values for: • Building foundation $1.2,576 • Storage building $33,600 • Light towers $276,854 • Scoreboard $26,115 • Goalposts $14,700 • Stairs $71.030 Total $434 875 The small storage building will be built by Keith Jensen of Jensen Home Builders LLC, 5 Pheasant Run, Lakeville, MA 02347. His license number is CS085870. �nc�rely y rs Jose D. Maiato j ect Manager �---� GREEACR-01 CEPA ACORO' DATE(MM/DDNM) CERTIFICATE OF LIABILITY INSURANCE 5/14/2014 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 (508)676-0309 NAME:CONTACT Paula Cer ueira-Melo Viveiros Insurance Agency,Inc. PHONE FAX 375 Airport Road (A/C.No Ext:508-676-1075 A/c No): E'MFall River,MA 02720 ADDRESS:PCerqueira@Viveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Protection Insurance Company 31879 INSURED Green Acres Landscaping &Construction Inc. INSURER B:Arbella Indemnity 10017 21 Malbone St INSURER C: Lakeville,MA 02347 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD L S BR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 8500025338 7/1/2013 7/1/2014 PREMISES Ea occurrence $ 100,00 RENTED CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICYLI PCT LOC $ BINE AUTOMOBILE LIABILITY COEa MideDt SINGLE LIMIT $ 1r 000 00 .cc A ANY AUTO 1020001609 7/112013 7/112014 BODILY INJURY(Per person) $ Include ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ Include AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ Include AUTOS APER ACCIDENT X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 10,000,00 A EXCESS LIAB CLAIMS-MADE 4600025339 7/1/2013 7/1/2014 AGGREGATE $ 10,000,00 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 9122700514 5/1/2014 5/1/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project:Brooks School Athletic Field Project Certificate Holder and Huntress Associates are Additional Insureds with repsect to Commercial General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Brooks School THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1160 Great Pond Rd. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD