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HomeMy WebLinkAboutBuilding Permit # 12/9/2015 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Pe.mit No#' Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page �rrMEN TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building One family ❑Addition E,Two or more family ❑Industrial ❑Alteration No.of units: ❑Commercial ❑Repair,replacement ❑Assessory Bldg ❑ Others: C Demolition ❑Other ❑Wa,,,tic �\\\m�\\�. DESCRIPTION W OF ORK TO BE PERFORMED: {Jl�Irld,�C.rt gF `st<ffc�� r={!U'O ✓�P/ "c Identification-Please Type or Prink Clearly _ OWNER: Name:��FFg-r— � lUla.a3,�>tiJC— Phone' '191-717/-4e!a5,3 Address: 0161— A 14nfJL+✓L Contractor ame� Av Phone v �yVA��\V�\v Super lsors Go strt\c o Icensev �\�\.�AI �y�a e �\_ ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT..$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: i FEE: Check No.: 1 L� 1 Receipt No.: ? NO'T'E: Persons colatractbng w'h registered c tractors do not have access to the err f d Signature of Agent/Qwrier ignatui'e of contractor- ': Plans Submitted❑ Plans Waived❑ Certified Plot Plan _. Stamped Plans❑ TYPE OF SE-RAGE DISPOSAL Dimension Riblic Sewec ❑ Tanning/Massage/BodyArt ❑ Swimming Pools ❑ Well El Tobacco of Stories: Total square feet of floor area,based on Exterior dimensions. Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tants oee. ❑ PennanentD unpster on Site ❑ Total land area,sq.ft.: THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ELECTRICAL:Movement of Meter location,mast or service drop requires approval of INTERDEPARTMENTAL SIGN OFF-U FORM Electrical Inspector Yes No _ /1LANNING 8�DEVELOPMENT Reviewed On a'�' DANGER ZONE LITERATURE: Yes No_ p MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine �'It' Signature_ 'd NOTES and DATA—(For department use) COMMENTS -- .. ... ._. _.. ... a CONSERVATION Reviewedon Si naturea �--- COMMENTS �L co HEALTH v Reviewed on giooaf,,— COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes_ - ---- Planning - --Planning Board Decision: Comments Conservation Decision: Comments Water$Sewer Connection/Signature&Date Driveway Permit - ❑ Notified for pickup Call Email DPW Town Engineer:Signature:_. .._ Located 384 Osgood Street Date Time Contact Name .._._.. _...____.__.-- _- FIREyD AJRTMENT�,Temp burrpster on sltei yes /r%/ii%�%ir/r�/iii -; /dir i io lr al /ri�r / i Locatorfa�124 ai S�eet���i�cf/��i Doc.Bmldmg Permit Revised 2014 Fjre De�artmen4 signature/date/�i///�/ori� , /r /r o i' /ice / ��/�/�,r A Will(nid N,)of oi,hii,hon 2x5 P IG''o c wilh 112'' 81'concrete blocks J_8 vi II",Ikh b4 W mv 5/8" Ej-ff-C 00 0=0POO B 0 0 0 J, 0-- 0 ---------- Remove foundation wall I H.A-A Fic,,li Il 13 rRemove foundation=, 20"wide x 10"deep continues footing L 7 III<te(jc Cols r icliwi F 0 CuLi—on,Orc, aT- Ah(\Mover Ma � pAORYry Town of 2 L ndover 100 � ,6� � � � + h ver,Mass, I p �qS gar.o u _ILD BOARD OF HEALTH PERMIT TO ® p,/�1 Food/Kitchen THIS CERTIFIES THAT.. `................. ...:. .. �(�ih,�M1, ���,AJ W, BUILDING INSPECTOR eptic ' y�YI Foundation has permission to erect..........................buildings on.. .... ;/'.JY 1 . n Rough to be occupied as .: � �.....�lt ....................... chinnnoy provided that the person accepting this permit shalverypect conform to the terms of the application ma[ 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 noa[ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough �+ ........ sa,0ca /Y ...r.�..:...�L .................................. Fina[ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildine Rough Display in a Conspicuous Place on the Premises—Do Not Remove Fina[ No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. J.K.L. REALTY TRUST CONSTRUCTION AND CUSTOM HOMES 22 Wicker Lane, Wakefield,MA 01880 617.257.4408 This agreement is for the construction of a bulkhead to allow an exit out of the basement. It shall be constructed as shown on the attached plan for the sum of$5,000.00.' Jim Luciani 71L � LoT#/A S NEPE6Y CE,cT/Fy Tp THE T/T[.E/,�JSU,fO,C,Orlp PL O T PZ- 4v G4v »'/TH>NE Y�'�✓ OP",ct�,quoa�C Za�/i,✓c LC6vc.aT S ,/ j+ S f.c7NCF cE�TiFY TN T TN/S p fL1i 6/SNOT - cac..TCo/H THE FE 4 /YLeP NNZA O A4EA. O,PA"tl1v FOiP �¢r'" �LitiYT zsoc9d Doose ss,�c De�Ecao.,�.,r�<P JEFfft_Y �,\v," �✓wr,r,/113 ���,:'F'.'nf^�?Y�„/„•C A,;,/-rte J i NaT FO,P p BavN Rs'��-ce.,�'J,ar ovDov p.v,er/.uF.rrs- /31EK,P/MAGI'E,uG.WEE,Pi.I/6 SE,P✓icEs A.VOOYE.C, hJASSaC.vvSETTS O/8/O North Andover MIMAP December 4,2015 ..Massdo� �� Qe Qr V 0 av e 0 .4 �rS �s�rvFOAMAr�o� ,����>row�.x,�E�sEo�n��s�sEo The Commonwealth ofl to orehusetts Department of ZndustrialAccidents X Congress Street,Suite 100 Bowww.mA02ovldia 7 www.mass.gov/did Workers Compensation Insurance Affidavit:Builders/Contractrs/Blectriciawffllumbers. TOBEFILED WITHTDg).'ERMITTINGAUTkI012TTY. PI PY't Leeibly AepUcmt1uf0mftti0 Name(sr,bese/orga�afionitna�wiaE,ai):-T/fL f�iVLrY Address: 7 ✓/CK��'�.R�U' City/8tatelZip:/,J/J/f'FI�)-)/✓Jim' O/8<40 Phonek: Areyon as employer?Checkttie appiopriatcbox: Type ofp,*rt(;eirired): I.Q Iamaemployerwith__omPloyees(ivll end/orpart-time)." 7.ONew---t-rtioA 2.©Iamasole proprietoror partnership avdfiave no employeesworking formein 8.QAemodeliug any capacity.[Nowmkers comp.iusuravice x,mod.j 9.❑Demolition 3,01emahomeowner doing all workmyselt[No woxkess'comp.insma¢cerequired.]'i lOQ$uilding addition 4.❑IamaHomeuvmer and willbehuivg contractom to coudvctallwerkonmy proaerty.Iwill 11. Electricalx alts oY additions swethat alicov�actors eitherbave workers'wmpensationinsmanceor are sole � oP proprieNm witHno employees. 12.0 Plumbing repairs or additions 5.®lam agenuat conhactor and Ibave Lvedtbe sub-coutractorslistedonWe attached sheet 13.QReo£iepaixs "These sub-conhantor's5adeamployees andbaveworkers'comp.ins<,mena.t 14.0 011ier GO,Kt;FA1) 6.❑We ue acorporation andix ofSpem Have exercisedthe¢rigM o#RxemptionperMGL e. 152,81(4),avdwehsve naeayployees.[No workas'comp.insmauce required] "P,�applicant the[checks tiarNl must also fill ovt thesectionbetow abowin&�eirworkers'wmpe¢satio¢policy informetio¢. tl;omoowners wHo sub'miEthvs aSfiaavltind3cativgthey are doingall workevdffienHue outside cenhactotsmustsubm(Eanew affidariti¢duatieg tach tCon4actors that check ibis box mustgittached as additivml sheetahowingthe name of the snbcontrectcrs and statewhetHtt or mtthose mtitiesbave. empioyees.I£$e avb-cankectors have employees,llicy must provide tires workeis'wmp.policymmber. . lam arz employer that ispPdvidingworkers'campensaiion Ensurancefor my employees.'Below is thepolicy andjob site informadon. heruranee Company Name: Policy#or Self-ins,Lie.#: ExpitationDate: Sob site Address: 4�o �u�6n-T city/Starizip:.r )y�UWlfi g Attach a copy o£the workers'compensationpolicy declaration pago(showing the policynumber dna expiration date). Failure to secure coverage as required bad.,MOL c.152,§25A is a caimb at violation punish bleby a 8ne up to$1,500.00 and/or one-year imprisonment,as welt as ci fl penalties in the form of a STOP WORK ORDER,and a fire ofup to$250.00 a day against the violator.A copy ofthis statement may be fmwaxded to the Office of IuvestigMins ofthe DIA for iosureree coverage verification. rdoo by Situ�n�'-th P�ht`s.1Peajury tT atthei rmatiorzprovided above is true andcmret. P"=0":, xns cer �.r �/•D D t �.C�GY�Lcij Ph = �/�/ Z3 /e� OffciaZ use outy.Da not write in this area,to be completed by city ar fown official. City ox Town: P—R/Lie-se ff Issning Authority(circle 1 1.BoardoMmIth 2.BmldingDepartment 3.City)T—Clerk 4.Eleetricalpuspecter 5.Plumbinglospector 6.Other Contact Person: Phone#: 12/e/2—e.=,AH FR°I,.rax T°.s1F,eaea_E41 aR_A.—°F eel A067ML CERTIFICATE OF LIABILITY INSURANCE `/' 12/8/2015 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:If the certificate holder is an ADDITIONAL INSURED,the p.Imy(ies)mus[be entlO—,I.If SUBROGATION IS WAIVED,subject to the lenns antl conditions of the policq,certain policies may require an endorsement.A statement on this cerlffi-te does not confer rights to the certificate holder in lieu of such entlorsementls). I— CT Lisa Mills Tarpey Tnsuxanca croup 11TON. .(781)246-2677 .11.U., 442 W St s Lisa@taxpeyinsuxance.co PO BI-567RER IAFF-1-COVERA Wakefield MA 01880-4667 RA Norfolk s Dedham Grou —EAealty Trust 22 Wicker Lane Wakefield MA 01880 COVERAGES CERTIFICATE NUMBER:2015-2016 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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, R I X BcuL UA 1111 A .1 X1—IR 'g 050,000 sorosna zs/zo s/zs/zoze —) 1,000,000 2,000,000 X I Al ol oo CT ; OpILELIApILn � �p RY(Pe.a_Ida 11T lrEl IC ° r N 3 ICT IL a — ATeHa,�EHIeLEe,A�Oap,e,.A,al�o�alHem„k=s��ee�l,,m�,,(ro.�.e,rma,=Pn�,_,4�,,.al CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town o£North Andover WILL BE DELIVERED IN North AndOVex,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. Mills/LSSA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(111411) J.K.L. REALTY TRUST CONSTRUCTION AND CUSTOM HOMES 22 Wicker Lane, Wakefield,MA 01880 617.257.4408 List of Subcontractor Greenwood and Sons Inc. ac -'p CERTIFICATE OF LIABILITY INSURANCE 2 e io s 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 REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMF TANT, OIDEN.IMPORTANT: If Ne—fi—bottler m an ADDITIONAL INSURED,Me policYUM)must be endowed. If SUBROGATION IS WANED,subject IA Me temLs antl wnd'Riws of Ne policy,certain policies may require an endorsement A stale 1 on Mis-.I—does not cooter no.to the certiflw[e holder in lieu of such endorsamerrt s. TRIM MURPHY PFARMfi FAMILY WESTFORD OFFICE .(978)467-1001 0855-978-5629 239 Littleton Rd(ESA a K7M.MORPHY FARM—FAMILYF COM Westford, NA 01886 .FARM FAMILY CASUALTY 113803 uxeo GREENWOOD 6 SONS INC 1 WASHINGTON ST. MELROSE, MA 02176 COVERAGES CERTIFICATE NUMBH2 REVISION NUMBER: m R Co RCIaL GEMEIL un , 1 000 000 imsmnoe®o cuff 100 000 2001L6312 3/1/15 /1/ m 5 000 16 A 1 000 000 GENERAL�R—Tlza 2,000,000 cy®Eo-® c s 2,000,0001 - elle w,alun xv tPe,ce�I 0S11111— R A oro ,uoem Ui1V N x 2009W6682 4/8/15 4/8/16 -- 500,000 o>aaa�nmxx)e 500,000 aEs( RD101,aaa'�u�elaemangy.sereade.maycexmaeammaa�wreisregamai EXCAVATION BpS STREETS CLEANING AN JKL REALTY TRUST 22 WICKER IN ccoxoaxcev THT 11 Faovlsoxs vnu DeuvexaD Ix WAKEFIELD, MA 01880 T R-C xePxEservra --�t j1MKYIACIANI@VERIZON_NET 0198&2014 ACORD CORPORATION.All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered malls of ACORD CONTRACT - 95traL 171734 ryc P rab n. V-12mw CBA JKL REALTY TRUST FRA- 'LUCIAN] - 22 �:KERLANE O - MA 01880 - Und 6 CS-051701 r FRANKJLUCiA*jR L J 22 WICKER LN - - WAKEMLD MA 0x880:..... L _ Commissioner 09113/2016