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HomeMy WebLinkAboutMiscellaneous - 40 HILLSIDE ROAD 4/30/2018�40 �N,Ils� de 2.,w2 BUILDING FILE wilz Location No. fy 0 Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ g Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# q _ 31407 � / Building Inspector ,i Commonwealth of Mfa;sachusetts r Sheet Metal Permit Date: Permit oa _. Estimated Job Cost: Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: NO Business License# Applicant License# 0 S133 :7 Business Information: Property Owner/Job Location Information: Name: Name: l, S C�i 10 Y _ Mr Street: 3 �� � Street:A0 1rtiUsSt City/Town,:�fluM ��� City/Town: Telephone:60 � 1�� Telephone Photo I.D. required/Copy of Photo I.D. attached: YES V NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses t Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu, ft. over 35,000 cu. ft. p Sheet metal work to be completed: New Work: V/ Renovation: HVAC \/ Metal Roofmg Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: i t f.; [INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.'112 YesjNo ❑ you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Othertype of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 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. nt. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0,I hereby certify that all of the details and information I 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 "i Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted lity/Town ❑Journeyperson Signature of Licensee 'ermit# ❑Journeyperson-Restricted License Number: =ee$ Check at www.mass.elovldpl nspector Signature of Permit Approval G Sheet Metal Commercial Guidelines/Life Safety/Critical System_s Inspection Checklist Yes No NIA, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided An workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access doorproperly installed and checked for operation Smoke and combination fire/smoke dampens with access doors properly installed- actuator checked for proper operation(May also be vezified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required) and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper clea'3 anees,fire rated enclosures and pressure testing required: • •_;•SFt�:;,�.i--;eN<<a:rnts instalir�';=rli�:t�r�quxred on equipment and�.�_.:�..:;-f4 '. • . . , _ Duct penetrations in fv e' atc =axl:Y and fla60scaled" Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0"maximum length c Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of extemal covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-of) Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A. Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with properjourrreyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximuin flexible run 8'-0" t: Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duet Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off) BUILDING PERMIT - F NoRT" 2Q���LED.�62 TOWN OF NORTH-ANDOVER APPLICATION FOR PLAN EXAMINATION ,y T n0 Permit No#• Date Received �R'0?4rrD P- RSSgcFlusT, Date Issued: - MORTANT:Applicant must complete all items on this page a �, s Yr tti ETM.— r t- M, p S ,t -._.s' i x f�,�"���•"a'" KS��� �, w. - ^' ° � c ,�' " g F �r. ; 5CATIONr tr�yt 'n 2 2 ,¢ L.O ;a'�� 'i4 F y -, w.ee- .:.a tYF+ a<+►;KF. .};'s. _.,..r� -lot- ,..t'..4 At --. d;i. ' "1. r mac' s �, ;r •tF '_`-`�`�FSa -�� .�� ,� �5�. , �,. �'�4'ae PROP'E-R�TY:®WEPOr _�__ ? � w _Pnnt 1 DD&Year StructureYes no (VIAP PARC-1 H ZONING DISTRICXT- s �' t His rte Distract ; ` � �xyes no - v � - -- ___ _ _ _ _ _ _ ac•t e Shoff illage� y'es 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 Vl/ell 0-Floodplain D Wetl'arids UVatersfied District ❑_Water sewer,._ DESCRIPTION OF WORK TO BE PERFORMED: F Identification- Please Type or Print Clearly• OWNER: Name: Phone: Address: Coptr-actor Name: _ -- Phone: _Address. li Supervisors Construction License _ ___ _ _ _ _ ___: z4 :Exp: DateE .a. - •Ho` 4�ove se e liri `e- �leen _ s m rm rit,L - _ t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.B ULDING PERMIT:$12.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i.___,I`otal Project Cost: $ FEE: $ ti Check No.: Receipt No., j NOTE: Persons contracting-with unregistered contractors do not have.access to the guarantyfund Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ r." F POF SEWERAGE DISPOSAL lic Sewer ❑ Tanning/Massage/Body Art ❑ ST�m-nming Poolsll ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dmnpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 4 - 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 Connec#ion/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT" -.Temp Dumpstor on site yes no Loeated at 124 Main Street Fire Department signature/date j ' new nn nrni-rn - -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: r ELECTRICAL: Movement of Meter location, mast or service drop_requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine I i NOTES and DATA— (For department use) I i ® Notified for pickup Call Email r ate Time Contact Name Doc.Building Pen-nit Revised 2014 _. , Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofiing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o .Building Permit Application ❑ Certified Surveyed Plot Plan I ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract Q Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products V®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) j o Copy of Coi ltr act o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products d®TE: 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 ai'the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 i -o: Page 2 of 2 2017-01-05 15:02:04(GMT) 16034323852 From: Financial Insurance Services ` A�V CERTIFICATE OF LIABILITY INSURANCE °ATE (MMtDD Y Y) 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 Patricia Blais NAME: Financial Insurance Services Inc PHONE( 603)432-6414 FAC No;(603)932-3852 PO Box 950 E-MAIL ADDRESS,pblais@fisins.com ' INSURERS AFFORDING COVERAGE NAIC# Derry NH 03038 INSURER A 14MIC 23329 INSURED INSURER 8: Joseph Desantis INSURER C Dba Jmd Mechanical INSURER D: 32 Shannon Road INSURER E: Salem NH 03079-1843 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) (MMIDDfYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE 5 A CLAIMS-MADEOCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurrence) S BOPI058856 6/25/2016 6/25/2017 MED EXP(Any one person) S 15,000 PERSONAL&ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY F—]JECOT D LOC PRODUCTS-COh1P/OP AGG S 2,000,000 OTHER, Employment Practices Liab Ins S 100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peraccident) S NON-OWNED PROPERTY DAMAGE HIRED ALTOS AUTOS Peraccident S 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S 4 EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORPARTNER,EXECLMVE ❑ OFFICER/MEMBER EXCLUDED? N 1 A E,L.EACH ACCIDENT 5 (Mandatory In NH) E.L.DISEASE•FA EMPLOYE 5 If yes,describe under - DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project: 40 Hillside CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE .. t. Sam Fragala/SETH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD INS025 onia m � . \¢OMMONWE�T , -. �� : ` ��L HOF � Q�f, ■ ?o \. . . e . » 4 <� , . . . ^ SHEE ETkL WOkf. SRES.THEFOLI WIN ObkN_E . . ��\ — AƒER uNRkSTR CTE\ > cc JOE m DESANTIS \ SALk $p ( � » « : .z. y yg } - . « ` « 42 &2%018:«215201