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HomeMy WebLinkAboutMiscellaneous - 1405 GREAT POND ROAD 4/30/2018 (2) AA Y NORTH q Il a2-�l� a� BUILDING PERMIT 3?��t��� b'6��a� TOWN OF NORTH ANDOVER " ° �^ APPLICATION FOR PLAN EXAMINATION Permit NO: J /� Date Received_ �CHUS Date Issued: 0 [ �o l IMPORTANT:Applicant must complete all items on this page LOCATION lJ Y14 r�_�` Print e PROPERTY OWNER n ie �Pub lba— Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villa a yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family 0 Industrial C,Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic rl Well n Floodplain 1 Wetlands ❑ Watershed District 1 Water/Sewer GL- 1 �f' ad &d 1 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: C a`-1 n vA,6CA_ Phone: 17- 579@- ���'� D rn-, � ��. tri_a &c� LL (p Address: �4q9 A,( un S+ Elea �11W A4 0 I -ID hit l m 1 �MA, Supervisor's Construction License:nc� _ J0 522L xp. Date: Home Improvement License: / n l f�Ll Exp. Date: q ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. o Total Project Cost: $ �� r� y FEE: $ '7a D Check No.: 11 S( Receipt No.: 0 NOTE: Persons contracting with unregistered contractors do not have access to a gu ranty fund Signature of Agent/Owner 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. r 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 NOTE: All dumpster permits require sign offrom 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 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 limension 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 droprequires approval of Electrical Inspector Yes No ®ANGER 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 r ate Time Contact Name Doc.Building Permit Revised 2014 Plans Submitted Plans Waived El. Certified Plot Plan ❑ Stamped Plans ❑ IYPE Z?F SEWERAGE DISPOSAL Public Sewer ❑ Tannin g/MassageBody 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 Siqnature 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 Location 14 05- 7 No. 4* GI 7 Date /0 ' /q • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1 4 , �/ Building Inspector c10RTH '9 Town of 1 ndover O 1. 1 i No. 8 h ver, Mass, I a • O COCHICM.wKM 1' ' A- P � s U BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System THIS CERTIFIES THAT .......3.L.WVr IJ AY,C t P A..... BUILDING INSPECTOR ..... C o� w.�.rl ........ has permission to erect 01) Foundation p .......................... buildings on ......�.yo�...�.!r��......... See ....... ..... ..... .. Rough tobe occupied as .......�. ....... ............ ..............cir .. ...................... 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 CONSTRUCTIO TARTS 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. GC160 Hampton Cast Iron Pellet Insert 267/8 241/4 -771 163/8 1 43 3/16 0 1101 339/16 Ulu[ 41'/8 113�4 a2215/6 A 12-3/4 GF160 Wood Pellet Insert INSTALLED AS A FIREPLACE INSERT STOVE MODEL (FPI) /A INSTALLE COMME UN MODELE SUR PIED DE POELE. Minimum clearances to combustible materials./ Les d6gagements minimums aux mat6riels combustibles: A Sidewall to center of unit(De la paroi au centre de i'unit6) 24" (610 mm B Sidewall to surround panel (De la paroi a 1'entoure le panneau) 2"(51 mm) C Bottom of unit to an unshielded 12" (305 mm)mantle (Le fond de I'unit6 a un manteau de cheminde non blind6) 33" (838 mm) D Unit to top facing (protruding'/" [19 mm]) (De I'unitd au sommet du parement) 0" (0 mm) E Unit to side facing (protruding 3/" [19 mm])(De I'unitd au c6t6 du parement) 0" (0 mm) F From door opening of unit to edge of floor protection (De la porte ouvrant au devant de protection de plancher) 6"(152 mm) G From side of unit to edge of floor protection (De I'ouverture de porte pour prendre parti de protection de plancher) 6" (152 mm) These dimensions are minimum C clearances. It is recommended that you D ensure sufficient room for servicing, routine cleaning and maintenance. V The unit must be installed with a minimum of 6"(152 mm) of floor protection in front Q of and to the sides of the door opening. 7*7 G F i D I, GF160 Wood Pellet Insert VENT TERMINATION REQUIREMENTS: IT IS RECOMMENDED THAT YOUR PELLET STOVE BE INSTALLED BY AN AUTHORIZED DEALER/INSTALLER. Letter Minimum Clearance Description A 24 in (61 cm) Above grass,top of plants, wood, or any other combustible materials. B 48 in (122 cm) Beside/below any door or window that may be opened. (18"(46 cm) if outside fresh air installed.) C 12 in (30 cm) Above any door or window that may be opened. (9"(23 cm) if outside fresh air installed.) D 24 in (61 cm) To any adjacent building,fences and protruding parts of the structure. E 24 in (61 cm) Below any eave or roof overhang F 12 in (30 cm) To outside corner. G 12 in (30 cm) To inside corner, combustible wall (vertical and horizontal terminations). H 3 ft(91 cm)within a height To each side of center line extended above natural gas or propane meter/ of 15 ft(4.5 m)above the regulator assembly or mechanical vent. meter/regulator assembly I 3 ft(91 cm) From any forced air intake of other appliance J 12 in (30 cm) Clearance to non-mechanical air supply inlet to building, or the combustion air inlet to any appliance. K 24 in (61 cm) Clearance above roof line for vertical terminations. L 7 ft(2.13 m) Clearance above paved sidewalk or paved driveway located on public property. AE D Opens — CG OpereB A IL ®Termination Cap H ® Air supply Inlet Gas Meter ®Restrictiondmnd Zone II I I GF160 Wood Pellet Insert OUTSIDE FRESH AIR CONNECTION RECOMMENDED-THROUGH WALL WITH VERTICAL RISE AND HORIZONTAL TERMINATION Outside fresh air is mandatory when installing this unit in airtight INSTALLATION homes and mobile homes. NOTE - This venting configuration is only for use with the A Fresh-air intake is strongly recommended for all installations. Built-In installation. Failure to install intake air may result in improper combustion as well as the unit smoking during power failures. When connecting to an outside fresh air source,do not use plastic or combustible pipe.A 2"minimum (51 mm) ID (inside diameter)steel, Termination cap; aluminum or copper pipe should be used. It is recommended,when you are installing a fresh air system,to keep the number of bends in theI e to a minimum. p p 90°e1bow i Wall framing Outside I Wall Vertical section' of vent pipe i i Wall strap E:�) 2"ID Optional (51 mm) Elbow Horizontal frame for thimble I MASONRY FIREPLACE clean INSERT INSTALLATION out tee Wall thimble Rain Cap Fresh-air intake Steel Plate or Flashing Damper Removed or Fastened Open Mantel(8"deep) Min.8"from top of stove 1� Clean-out tee Min.6" If holes already exist fresh-air intake can Floor be taken through the Protection back of the fireplace n or through the ash Masonry Fireplace Combustible Floor dump. 4UD GF/60 Wood Pellet Insert OUTSIDE VERTICAL INSTALLATIONS INSIDE VERTICAL INSTALLATIONS Rain cap—0 Rain cap—0 24" 24" (61 cm) Flashing (61 cm) Flashing 3"(7.5 cm) 3"(7.5 cm) Clearance Clearance Support bracket Support Tee with bracket cleanout Type"L" — vent Tee or 90° elbow t} Type "L" vent ' 1 (Z5- C� �1 COLON-1 OP ID:TL ACOR,D�' DATE IMMlDOIYYYYI 'CERTIFICATE OF LIABILITY INSURANCE 1E4MMID rry 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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 endomemengs). PRODUCER CONTACT Wilmington Insurance Agency FAX P NAME: Wilmington Insurance Agency_ Five Middlesex Avenue Unit 14 Arc%,F�di:978-65_8-3805 P.0.Box 1010 E-MAIL ( ,N,);978-657-5724 Wilmington,MA 01887-0580 ADDRESS: _ John F.Doherty INSURERIS)AFFORDING COVERAGE NAIC M INSURER A:Ace American Insurance Co INSURED Colonial Fireplace LLC INSURER B:Arbella Protection 41360 474 Main Street INSURER Securi Insurance 24082 Wilmington,MA 01887 _.. _ _ 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 ANXNO UBR •' LTR TYPE OF INSURANCE , POLICYNUMBER N1MlDDNYYY MM/DD/YY P LJMITS C ; X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS MADE ❑X OCCUR BKS56005897 03/1412096 i 03/1412017 DAMAREI4D PREMISES(Ea aocurrence) $ 10,00 3— ----- MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LLMITAPPUES PER: GENERAL AGGREGATE L 2,000,00 X JECT POLICY L7 PRO- F-]LOCPRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED ISINGLE LIMIT g 1,000,00 B ANY AUTO 1020028151 04/0112016 04/01/2017 BODILY INJURY(Per person) S �— ALI-OWNED X''SCHEDULED I - _ AUTOS AUTOS I BODILY INJURY(Per acUdern) $ X HIREDAUTOS X MON-OWNED AL1 PROPERTYDAGE AUTOS (Per acciden _ S b I UMBRELLALJAB OCCUR EACH OCCURRENCE S EXCESS LIAR I CLAIMS-MADE AGGREGATE_ S I DED RETF1JT10N3 ; S WORKERS COMPENSATION I PER STATUTE X ER H AND EMPLOYERS'LIABILITY X A ANY PRO PRIETOR/PARTNER/EXECUTIVE Y� N/A 6S62UB2E12396214 04/01/2016 04/01/2017 E.L.EACH ACCIDENT �S 1,000,00 CFFICERIMEMBER EXCL'JDEO? (Mandatory in NH) ff yes,des^ribe order E.L.DISEASE_EA ENIPLOYEE,1 S 1,000,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,00 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached irmarespace is required) CERTIFICATE HOLDER CANCELLATION TOWN-28 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. 1600 Osgood Street Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I �'d t1ZL9 L99 9Z6 Out AOU96V Sud uO;6ulwl!AA d 6t,:Z0 9 6 t10 Massachusetts Department of Public Safety ` +„r�,ro�r�ur�rflJ cy/'C3/fi�crt�crcfruc/ ® Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation License: CS-105920 ' . " ME IMPROVEMENT CONTRACTOR Construction Supervisor egistration: 181414 Type xpiration 4/11201,7 Corporation SCOTT M HAYES � COLONIAL FIREPLACE 6 CANTERBURY AVE :) t� HAVERHILL MA 0183&", ? SCOTT HAYES b 474 MAIN ST n , , WILMINGTON,MA 01887 Undersecretary Expiration: } Commissioner 0811912018 t