Loading...
HomeMy WebLinkAboutBuilding Permit # 8/27/2015 "ORTFI —�3 DING PERMIT TOWN OF NORTH ANDOVER E APPLICATION FOR PLAN EXAMINATION " a Permit PIO: Date Received ro 8 Date Issued: : ", 2 � IMPORTANT:ARPlicant must cognplete all items on this pgge LOCATION t w PROPERTY C*NtR f 00A , MESF NO P F PL 6, 01 OtSTF�1 ;a h]Iet 5tac �tKc� yes Mdkhih 'Stipilla9e TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential rl New Building b'KOne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: ❑Commercial epair,replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other U Septic-,U Well ❑Floodplairi � 1!Wetlands �U Watershed[district ❑Water/Sewer r Identification Please Type or Print Clearly) OWNER: Name: Phone: G Address: Lc. COPJTRACTOI2 N,nio: Ptioriea ' 1 �g Su p,erulsoeid nstrll t6n Ltcertse HorrreIr►iprvrir►ertt�Lioensy., Ex `fiat ;` ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$ "0' FEE:$ � Check No.: Receipt No.: t l NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow r Signature of contractor Plans Subrnitt&FT" Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS Public Sewer Tanning/Massage/Eody Art ❑ Swiunming 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 7�� PLANNING & DEVELOPMENT Reviewed On k&65" � Signature � COMMENTS e CONSERVATION Reviewed on Si nature J\ COMMENTS HEALTH Reviewed on Signature COMMENTS I^� 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, -'Ternp Dumpster onsite yes - no Located`at 124yMain Street ° °,°; Five Departs enf-5idpOture/date COMMENTS AM ®RTF lu 11 U12 E ®ver O ® _ "'� iL _ h Ver, Mass, cocHIcHewIc« � -✓®AERATED P'4A�'4� S U BOARD OF HEALTH P �E� RMIT T LU Food/Kitchen Septic System THIS CERTIFIES THAT .............. BUILDING INSPECTOR ................ .. ................ .......................................... ....�... Foundation has permission to erec ......................... buildings on ............. ...........�k.1144L........®.. ......... gh to be occupied as ..... ............. .. .�. .......... .. i o.....;� .... .... ,�... ... tmmney provided that the person accepting this permit shall in every respect conform to the terms of the applicati n 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES I ® THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S Rough Service .. . .. .... ............................ BUILDING INSPECTOR Final 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 all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. JMF Construction Georgetown,. Massachusetts John M. Floyd: 978.833.6191 Mass °onst°rUCUOIII Supervisor Illsid:,ense CS.,096834 Estimate for Joanne Mackey August 19,2015 278 Hillside Road N.Andover, MA 978-609-4821 Work to be performed: • Remove existing deck and dispose of all debris • Dig 4 sonotubes 48"deep and pour concrete • Pour new concrete pad (size TBD) • Overall dimensions for new deck: 6'wide by 21' long;this includes 6'x 10' upper deck,2 sets of stairs 42"wide each, and a landing 42"wide and 36" long • Remove the brick stones as needed • Estimated Labor& Materials Cost o $4,850.00 (permit not included) Contractor Signature John M. Floyd Date Customer Signature_ Joanne Mackey Date_20 August 2015 Project Page By Date D pp Client� ., G "� ' � Checked w Approve I — Date �" do (.. k j )J c� N " n 1�b. oct�8s,� LS/L7E �AU s S ,yEPE��' CE.cT/FY TO TyE T/TLE/,c/SU.eO.!' 4,v0 �L V T TU 7.�/E B.4N.Y 7H•9T T!/EO/►'ELG./.ctt/S LDCATEO O.v Tf/ECO7'.•IS S,SbAr�.s/A.VO Tf/i4T?OAFS C0.1/FGtPir1 //� IY/T// T.�/E Taw�' OF n/o.A.�na��e, ZONJ.vG c�E6vLAT,t�.t/S ,�6,•le0iw 6ETa.�crs F.eO,s!STREETS�GOT L/NES. �' /va. .�uvD��� /�i�S S, s fU,�T.s�Et LE.CT/FY Tf/AT T•f'/S OA✓ELL/NB /S�t/OT :�;�WA V 4a LOL'gTEO/N TiYE� FEOE.PAG F,CGioO f/i4Z.4.�p A.PE,4. � �SyGivit!O/V FE�•4' �'OM.�1t/N/TY P.ltIGL '� �� OF,N,� JE 9s- 1-10 HOF- MANN . 4.` ti #36381 40� - slo�P� �fE.P,P/it1.9Gf'E',[iG/•t/EE.P/.1i6 SE.P�/CES A.t/ODYE.� �J.4SS.4C//!/SETTS o/8/O North Andover MIMAP August 24,2015 I i l 1 I �I r ��; ir� i �iFii r ) V A I i hili li II I m) a' Q MVPC Bo Interstates Horizontal Datum:MA Stateplana Coordinate System,Datum NAD83, -"'I Meters Oata Sources:The data for this map was produced by Merrimack —SR pORTiy Valley Planning Commission(MVPC)using data provided by the Town of Roads Of eau Norih Andover.Additional data provided by the Executive Office of y",Easements ? q�»t E�e b� Env ronmental Affosairs MassGIS.The Information depicted on this map is 3 L for planning purpes only.It may not be adequate for legal boundary Parcels F ti»—� p definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING >F - THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY {t = '+ 1} OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT tF eegq ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ,� o^AT`o��F•y.(°p THIS INFORMATION �SSACHus�t 1"=37ft ` The Commonwealth ofMa_ssachasetts Department oflndlustri rlAceidents 1 • : .d 1 Congress Street,Suite 100 Boston,AM 02114-2017 V°K www rnass.go vMia sy. W kers'Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumbers. T, O ,F"D WITH THE T��TTIN MORITY. Aplificant Information �' Please Print Le 'bl NaMo(Business/Organization/Individual): EE: .Address: �� ��� �Si.� ��� �v����►-�,• � ` City/State/zip: �• � rJ Phone Are yon an employer?Checktiie appropriate box: Type of project(7 quired): 1.L9 1 am a employerwith . : employees(fulland/orpart time).* 7. n New construction 2.WI am a sole proprietor or partnership and have no employees working for me in 8. Ej Remodeling any capacity.[No workers'comp.insurance required] 9. El Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance requited.]t 10 F1 Building addition 4.❑I am a homeowner and will.be hiring contractors to conduct all work on my property. 1-will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. ft plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Fj Roof repairs These sub-contractors have employees and have workers'comp.insurance.t ' � 14.(�C Other 6.Q We are a corporation and its of� ers have exercised their right of exemption per MGL c. 152,§1(4),and we have nQ emplayees.[No workers'comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who subirAt#his affidavit indicating they are doing all work andthen hire outside contractors must siibmit anew affidavit indicating such. ?Contractors 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-c' racfors fiave employees,4tiey const provide their workers'comp.policy number.' .dam an employer that ispioviding workers'compensation insurance for my employees.'Below is the polley and fob site information. Insurance Company Name; Policy##or S e1f ins.Lic.##: ��Gl Expiration Date: Job Site Address: 1 �t p: Attach a copy of the workers'compensation-polley declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o.152,§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. X do hereby certify under the pains andpenaltie ofperjury that the information provided above is true and correct. +l Date kA Sign 0: Phone# � ( 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone It: A,R" CERTIFICATE OF LIABILITY INSURANCEDATE(MM8//21/ 15 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 CONNAME:TACT Georgetown Insurance Agcy, Inc PHONE (978) 352-8000 FAX No; (978) 352-7719 10 West Main Street ADDRESS: info@ Georgetown Insurance.com. Georgetown, MA 01833 INSURE S AFFORDING COVERAGE NAIC# INSURERA:Commerce Insurance INSURED INSURER B:Travelers John Floyd INSURERC: dba JMF Construction INSURER D: 26 Parish Road INSURER E: Georgetown, MA 01833 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 ADOL SUBR POLICY EFF POLICY IXP LIMITS LTR TYPE OF INSURANCE R POLICY NUMBER MM/DD/Y MM/DDIYYYY A GENERAL LIABILITY BGQBVP 7/2/15 7/2/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERALLIABILITY PREMISES(Faoc ace $ 100,000 CLAIMS-MADE [K]OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2, 00,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,00 000 }{ POLICYPRCT LOC COMB AUTOMOBILE LIABILITY accident) NGLELIMIT dent) $ BODILY INJURY(Per person) $ ANYAUTO ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED eraccidenl $ HIREDAUTOS _AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION OG135305 7/3/15 7/3/16 X WC SLM r OTH- AND EMPLOYERS'LIABILITY Y/N E.LEACH ACGDENi $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500.000 If YYes describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) Operations usual and customary to the named insured. Sole Propietor, John Floyd, has not made an election for coverage under workers compensation MA Limited Other States Benefit endorsement applies to workers compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover, MA ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Stacey Croteau ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: bemery@emeryconstruction.com ( 'C9tr 'r `rr�tr�reGrrrr� r r f/lrr.t,drrr ✓r.drrtd v Office of Consumer Affairs&Business Regulation 77 ME IMPROVEMENT CONTRACTOR a Type: 6 registration: 182684 - _ DBA expiration: 7/1512017 JMF CONSTRUCTION` JOHN FLOYD 26 PARISH ROAD GEORGETOWN, MA 01833 Undersecretary Massachusetts - Department of Public Safety Board of Buiiding Regulations and Standards License: CS-0968834 ITS (, x is JOHN M FLOYD 26 PARISH ROAD GEORGETOWN;V" �✓,�.-� --� �� � >> � `` expiration Cornrnissioner 0412412016