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HomeMy WebLinkAboutBuilding Permit # 10/15/2015 BUILDING � uORT11 lJIL I IT ®�'I T NORTH V z APPLICATION FOR PLAN EXAMINATION Y n Permit NO: Date Received Date Issued: US IMPORTANT:Applicant must complete all items on this page „, ,,,,,;, r r/ v ./ r./ r n,r/1 i r � ,r. /.. , ,ir r. ///.. ✓/r...//, ,. ✓/ r,/.. /.,�/, i/ / ,.., ,% r /,a"r� r ,,,, ,< r r / „ , ,, /r„r rr /i, r.,,,,rriiiiri/ ,r ,r// rr �ii// �,li/// /,r, r ri, // ✓/ / a /it,/ %// ✓ / / r,. / ,, /, r ., ✓ ,, r iii /,/, / :,. r, ,, r, r r o,: r � ,.. r, ../� r// ,/ r r / / ri.1. /1 / rrr✓ /// r r/ /i // ,,,,////,. %r rrr, .l, /i r,, /i/.r rJrr,% ✓�,, r � l TYPE OF IMPROVEMENT PROPO rtED USE Resi e°r7tial Non- Residential ❑ New Building krOne family ❑ Addition 11 Two or more family 11 Industrial El AWation No. of units: ❑ Commercial IpRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �i ir,:❑�/1l' II� r' r/,�// , F� ''/ r //�'' °fir�� rid r 1�//r`U�� f 'r ° I/ Iftl� r� r ,,,,. ,,,,.. /,,,i r i , r �/i//%r:////fir,/: /,/�„✓ ,;,/// ,..y:: / // ///////// %,! o,/ir /l ,, Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: Lq 41 k Ayu��-,r rrrr r r J rrr � r r �� „ ,. <; / rrr. r ,.. .✓ rJl/ ..r� ..� �/// / / ,� , / / ;r, v ,:, /r,,. -,r ,// / ✓ f/ ,./r.,r. .,rrr r, ,,o / r r r r ;,?, rr „„.,rii /c ,. /il,,, /r„,,,, /r,//�///,,, ,/i %r,,, r/„!�//i//, ,r„r / „//,,.. ,., ./ /, rr✓,.,, r„r /r..r / r/r/i ,, / r r r / r r i ,,,,,,,,.i rr -;.rr/, ,////�i,,,///” it//i//, /rr r.r/,c,/i„,,,.` ,,, ,,,Y,.”.ri ,c,i,//.r,//,,,,r�i„//r,r�„ii, r/�.,,�„/ ✓„r/,/�,/ir/�ir r/rr,,,//// „:.�//��/ ,,,,.,,/,,,,,/r//2%., r ��/,,.(/%//� r� r rill. rr r r rrr r / ri // ////r i ✓,i / /, / r r i i/, //,,,, r// / � /,. // , r.r rrr/ ✓„ � r „ / r / /%// �r /�/ii/r%i � / /j/i�//r/�///r/////rGr ,r„✓,ii,/�;,r,, �i;w//r ,v,,� /�,,,., /r r ��////;/i//i//oi r,/„,G r /,/� /,�,ie%,,. r /i, r , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i Total Project Cost: $ FEE: $ Check No.: Receipt No.: q4 3 NOTE: Persons contracting wi h unregistered contractors do not have access to the guaranty pend ign tore ofiAgen tQuu er $,ighature�,of� rat tia t r �� . FORTH Town of '� sndover O ,' 0% Z � C' h ver, Mass, ] fir' COC LAKI RATEc) S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System A A & BUILDING INSPECTOR THIS CERTIFIES THAT .................. .. 1�" .. ..... ......... .... ........ ................................................... Foundation has permission to erect .......................... buildings on . .. :.... ..... g Rou h tobe occupied as .. ......... ....... ..............r...... !! ...................................... Chimney provided that the person accepting this ermit 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 S S 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT Temp Durnpster on slte yes no ifleated a#124 Matn Street F��e Depart�»e�t s��rS�tut�e/��te V,QMIUIENT� r 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2012 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 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 ❑ Copy Of Contract ❑ Floor/Crossection/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:INSPECTIONAL SERVICES DEPARTMENTMITORM07 Revised 2.2007 ne Commonwealth of Nfasstachzrset s Department ofIndustriralAccideno Ofie of.investigations X Congress Street,Suite 100 Boston,,1f9A 02114-2017 www.rnassgovldio Work=ers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Pluinbers Applicant Infor=gon 1'J ' ' 7 ( /� Please Pgint Le 'blv aMe(Busine&OrganizatioalIndividual): / !'- 0 f�gA Address: ` City/State/Zi : _ r Phone : r- Y'-V' 3 r - Jt Are you an employer?Check the appropriate boa: I am a employer with t 4. ❑ I am a general contractor and I Type of project(required). employees(full and/or part time)* have hired the stab-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling { , ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' [1�10 vmrkers' comp.insm�ance comp.insurance Y p- ❑Building addition required-] 5. ® We are a corporation and its 10.❑Eiectrical repairs or additions 3-❑ I am a homeowner doh all work- officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL insurance required.]t c-1.52,§1(4),and we have no 12'2 "ep irks employees. [Na workers' 13. ey comp.insurance required.] {I X 42 'ARYaPPlIcaaIthaErh0c box ifs mustalso tilt ontihe section below showing Weir workers'compensation policy information. I t fIomeowners who sabmitthis affidavit indicating they are doing all work and than bice outside eanhacbm must submit anew affidavit indieatingsocb f xConbactors that check this box must attached an aadditionnt sbeetshowing the name oftlw sub cp111Tadors and state wheffieror not ffioseenfi6eshave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an eiaployer titans providing tuorkers'compensattorr insurance for my employees. Below is the polic iy(rnd jab sire f iifonnadv Insulance Company Name:_ C t (Ctsin� it -'GtJ .-- Policy#or Self-ins.Lic.#: (i7 - 0 0 � Expiration.Date: Jam` L Job Site Address: City/State/Zip: Attach a copy of the workers, compensation policy declot'tion page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 13e advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify i er he ins and penalties of perjury that the NOMatian provided above is trice and correct. f L f Phone#: i Official use only- ))o not sprite bt this wren;to lye completed by city or town offreiaZ f City or Town: Permit/License# t Issuing Authority(circle one): X.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Aug-24,2015 01:03 PM Valp2LkNH 6034322522 PAGE. 2J 2 MA Ril f)s,1JJ61tp GTRZ+J)lrQQ09aT4 r. __— fii nPp fJ2W 0p ' Gonirngl$ •• _ 'tl: 't )vrrryr P,:detnlIli 02042020if?b GorpnrYlYHalrDlu■+tu7b4(t4Wltrns.NraCWMMhtf)t170�v1xt2itt(n}YnRPSbAOfa,rnwew•SWt+dm , tttt3 COMMACTAll 7tl�_.,.,_Il day lit j t / 17.4 Cill :�.� �0_►a'"""Iwl vnrgt ute utv,ul,•Stun NEW»tics c)pornlh,a,LLC, NL•WI`It011 g r NFWHT;p••, ,heacfJllOd W01t,at Ut0 j,ItlYrNllUtellOVBtod Rr lyeralion han,Inunly Inututo,atfr jutritUh at IrLor yup rHYb�0r�o4oa�Pp/Yo(rUy<,gy�i-"" . 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Eu 6UC Jsruik �tovsA /rwa• �33,�(,6.7Dj vz�ll 'til Cw 4 9rayvaAy 6 ,Fal GSvu Ar(a ' ................. ., aWRorhnY r�tAkrrqururd AlGlnrlalhhlean-axulrt1Mdill ria an ttproav ip fltb tormsl a d out t �- aueeinOnJ(Y nptaoa to tyP(ty tokat G+stlh F'rtao 2 lionlr e)1 rho front Stud the Mevdmn Of inlit,AOmonfill 4Wri attdaruforo ifi thlstthIs hIIWVmUh 1 t ?Work be)nQ pbrfurmotit anC(7)work riot saia orally efoVl6ffir Of _ and scny atlggtiMenils vonlltki tH)of lhapr0{Mao■Mldo h i1 poNobtad' Owner , dotq of Ihlti tra.aoc r}plat to oant;ol ihiA traneaOtto o et any tfine prtnr to 111)tt111nht orihe Y Nn WPRt3, owhurhste)roe. 0 Nor fflon Rnd i)Wuur w4r prOvldrd with tWp(<)oOpJee if a ogNueltNtle lhlr�bp1{lnaaa Jai+IfiOY tin• gi[1H YH)n 9p}17 ffgC7lr+1)fCRfft AlitE ANY ALAkK gpACCtl, iI for opplhlnfn,y tht4t 1Jtlht, (Rhuda Itlland mateF Ortty}7 Noticu to bpyQrl tJ)Qa not 1i)prt(1110 nprounugt if any ut th•cpbray lfitondad tar ilio J9read{nrrneto gg040lit of Ilion aval)pbIV inform 41,or,erg loft If, nk.SZ yuy eru Ctllltiodie.a$Orlypdad f ' Ll InnenRl lyaw m oU Vntjfr d1vto fieyetanytlrnVpay611thefullunpatopolf"iof""Iftta6i111M te�mohtr tufd In oo iiq)nfl you m)y hot RntitTlld tv receive a ptsrtlet yebaffrt of(IIP finanOv and hluurbnoe alfars)uy, (qy Who aallrr III no rtyrllt It,LtnJpWfully Prt(IlrVill proriiteare Gr aanlrntt Uny lirOdvh of the poill till rvl)opvuYc opolfo puenbygoU uhdur Ihlk ARreetnbnf,'(5)YOU ruby control thr>,Apreodi i if it hats Stuff been elntl■if al(ho mnlii Vi'tibe bY}traee thubaflur,tTrovJdoilyavnr�tHyth®vgliorathiooTt9eYmAtnornaoorglAtlChefflocehpWpin h ruptefcrbacraplttRodm■It,,.1■)ilt9hallbi aA fiotflcelrr wis(e)s rho buyer stone flirt Irl em P rod Nnt ruler then mldnttPub or)he wird a t rdri .yenr by tit1Ulha>:puamyepylnppefl ure:�leat)atlgbfnnefurN�yandrin hOryV,! OUWhrb tlti"yrlt((y'p Btsdgyph Y Y h►epginrlwrriidut(vorm 14 11. n e><phnetlen of buyer•,,rtgh(E, (ttJlusja fn}ant)gala:out 4gard a Y). vwnor ttaknbwrutrpa¢rlat:apt of rokufr,ra aanttaoterrt raNc ' Vnwnmor Pdudh{tun m.teHalrl, Rwp n oo L ennlnil �..w.,o.,(P Wt}AN6111itJ k)i)• - �WOO I anaCluUn ")YdH►mrl ttwF_— 11 NlhrlF'NOrJ�/plJtlu+ QtVQI, roJ ��""_ U RCQI� ...�....._ w UBrld u�, wm tv"PlWall CMWn .... YCLLr]Sv:ntKlnn o,'n nu tI+UV• ..r,�•,• nm r• f,,,n 5 f9 ��Ftd Z���Z86E09 11t_>1'gdTl,A WIT 60 ZT 5TOZ't F 5nV CERT'IFICAT'E OF LIABILITY INSURANCE F DATE(MMIODIYYYY) 5/1/2015 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: 1;the certificate holder is an ADDITIONAL NSU IRED,the policy(i0S) 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 co Mal jy33a P1llCJ Mackzntire insurance Agency Inc PHONE 5 ( 08)366-6161 No I LFAAXNu.1508)366-5202 11 West Main Street E-MAIL lissa ADDRESS.mep@macicint:.�Lre.cam Westborough 01582-1931 MSURER AFFORDING COVERAGE NAIL K MA INSURED INSURERA Netherlands (24171 Newpro paerati;3g LLC INSURERS T. err MutuEi/peerless 1241-98 J 26 Cedar St- INSURER C Acadia InsuzanCe Co _ INSURER D: ` INSURER E- T7oDarn `'� L=fA 01801 ItiSURER F_ -I COVERAGES CERTIFICATE NUMBERiiaster 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 114SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOWilTHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHEP,DOCUMENT WITH RESPEGT Tp A/HICH 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 I AOOL SU - LTR i 'TYPE OF INSURANCE N } BRI POLICY EFF POLICY ECP POE ICYNUMSFR _ ! R4.UDD 113rd100 UIRTS � $i COLRIEP,CIAL 3ElicRAl LIABILITY , EACH OCCURRENCE S 1,000,000 A• i CLA04S-MAOI t�OCCUR i DAAIAGETO R P c9 1 i I FREtdISES(Ea csOrenc s 1G0,000 l ' !CRP 85695?7 12/31120141?2/3?/2035�t{EDr�Lo(amjanepersonj )S 5,000 ( I I GENILAGGPEGATEU 1TAPtLiES?2R: (I( ! { S I PcRSOAAL8A0VIid1URY IS 1.000,Dun LQLICY1 1 ! GENERALAGGREGATE I_ 2,000,000 f_t JECi LOC I (PRODUCTS-COA'.PIOPAGC- S 2,000,000 OTHER: AUTOMOBILEUABILIif I ! ( I COMBINED SINGLE LIMIT ! 'Eae�denU 5 1,000,JDO p I t ANY RLOD BODILY INJURYersdn1 Per S (ALL ONS:ED (-- I SCI-EDULED ! l P AUTOS I AUTOS 1 I�. ESESIi: 1-21-3-1/20-1. 32/31/2013!BODILY NVJURY(Perect:deni) X HIRED nUi05 X ALTOS ; ` I PROPERTY IMUAGE (Per accident! 15 d mworisl PAsp5I fmil 1 5 Z i'),coo UMBRELLA LIA9` rerl Lre X{OCCUR l 1 l i� EXCESS UAa i EACH OCCURRENCE Is 5;liJli 000 3 ! i CLARASWAD`c1 i i AGGREGATE i 5 5 000,000 I DED i x RE,.tiTIONS io,Bao! ? ICU e582S76 }xz/3�/zo_�j az/3_/zois' IWORKERS COMP !5 COMPENSATION l S PER DTH• AND EMPLOYERS'LIABILITY Y/N STAillTE I ER I ANY PROPRIETOPJPAP.TNERf'rJt=CURVE OFFICER1116MBEP EXCLUDED? !�1Nra� j l �E?_ECHACCIOENT is 500,000 C ,(Mandatory in NH) II i 1 AC-20-20-003506-02 5/3/2035 Sl2/20?6 F-L DISEASE-ER EEMPLO:4y S 500,000 l l(yes,dzsaibe under I I ! OEasdfl T lON OF OPERATIONS bel= , { !EL DISEASE_POi}iN LIMfr(S 500 OOD i I I ` 11 DESCRIPTION,OF OPERATIONS I LOCA T IONS I VEHICLES(ACORD int,Additional Remarks Schedule,may be attached irmore space is required) '.. CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To T&om It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Timothy tlioynagh/MEL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS0251�Dienal �' 1 Sc�rrd c•f:�uitdiru; Requiat;o:�s and Siae,da;d: C ,ntrrn�t! n Suli�•t-•.iti>r Cfcem e: CS 096093 THOMAS E PE IgOC P.O.Box 50S p d .i ti Seekonk 1I'I4, 02771 1�N4�,,i,��, 4� Expirati Coann rssroner 04108/24 „- �� ( Y I P c�Z f C�� P 4 ` Y Office of Coa-isurner Affairs do Business Regulati®n l0 .Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 146589 Type: Supplement Card Expiration: 515/2017 NEWPRO OPERATING, LLC. TOM PEACOCK 26 CEDAR ST_ - -- - - -- -- WOBURN, MA 01801 -------- Update Address and return card-Mark reason for change. Address ❑ Renewal n Employment F-1 Lost Card ' -.'-'�r �ir,.ir i,,r/ui;vi%�� �-'�i�nJ.,iir�i�Jr•i/� frice of Consumes Affairs&Business ReguSation License or registration valid for imdividul use only fj "s' 3:d ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � office of Consumer Affairs and Business Regulation LRegistration: 146589 Type= 10 Park Plaza-Suite 5170 Expiration: 5/5/2017 Supplement C:,rd Boston,MA 02116 NEWPRO OPERATING,LLC. TOM PEACOCK 26 CEDAR ST. __+_.:.._----- __ �l ��'� -.✓,� /; WOBURN, MA01801Not d vithoutsi nature Uuticrsecrctaru g