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HomeMy WebLinkAboutBuilding Permit #91 - Bldg-7A-Groupe Schneider 8/6/2007Permit NO: V Date Issued: L—(Z BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received NORTH OF�t�a� �6 bN0 °t DESCRIPTION OF WOR 0 BE PREFORMED: _0 � a- 30' .r-7'�5-' f ®on�� 1��� air g;/e/o7 ,s1 A'Id-Z Pte. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. �a Total Project Cost: $ �� FEE: $ Check No.: D? 61© Receipt No.: �90 NOTE: Persons contractin ith unregi tered contractors do not have access to the guaranty fund Signature of Agent/OwnerSignature of contractor < —F -- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED Stamped Plans ❑ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (Atic tank, etc. ❑ Permanent Dumpster on Site ❑ 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 Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 2 1 A —F and G min.$100-$1000 fine 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 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 DEPARTMENT:BPFORM07 Revised 2.2007 Location / No. 9/ nat TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Ar.t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # OeK 2 0 4 65 2 Building inspector m m m m m y mm v y C � CAD CD 'O O MZ y 06 � CC12 C CZ y CD o v CD O CLQ CD CD O CD C CD yCD� d O_ y CD I � v CA, o CD CD Z O CD O CCD z r m W cw gag: � m � y g m n m A C n m Z N �'Cp NJ -I .. o a d m m p CO N0 CA N =r o = >_ > O N . O A d O N, coZZ =r Sh a o C3. ~' ... . m o O m N mCL m N O p� co') N O. d : ' Q C �a N m m -� IE o N N N J m O s N O m w ;�o =r CD o CD �o Ate.: maA: d� C - o gym: c.' nFS" gym: z O M. H 0 o tz ?_ �- SSS a- rcp w g x a tz R. 5 5 5 5 5 � w I— z w U HU) aZ ZC/) 0Z Q tiWrn LO w M U IL — 0 rn co 0 elf Q w H U) w U Z i� ca 0 o C� L � a) c .f U O � � r NO N cc co a) Q. a) U > 0 o in cut I, --C U Q o aa. U- U U L En i O ' Q a) ca cu C3 o U vn a 2 ++ •V O E ca C: Q. o E o � v a) ) LL ''•L... ai m a) U tB a t w- _ O ca .0 ns i +_.. U U cu a) �«_ cu E L U U U O U!�— 0 U- 3 3 7 X 3 0 m CD wz LQ CD 'ZU � O U 0 C O �t Q � U ch p c� �a CU® ME a Q) in Vl �. Z 7.0 $ L C CD Cl) LLN � U CD O I.. U CL N (U C O CV a � � Q cc ..0 a N U a 3 IC) z U) W_ 0 Z _ 0 U Z Q H Z W m F- CL w 0 F - Z LL. p Z � 'o Lu a) � _� w it a- ul OU Ei U p ¢ z 0 Lbt Q Q w� cu w. cac)_� (1)U Z p Q U Q_ N L a IrZ a �a am' j w<z-0M �w �_�., LU Ta C) E "d IJ V cu E cu 100, NU 5 �*� C 5° 5 i a) 5 5 L S�a2W 5 (� Q 5 c�5 z Z O w a Q w I— z w U HU) aZ ZC/) 0Z Q tiWrn LO w M U IL — 0 rn co 0 elf Q w H U) w U Z i� ca 0 o C� L � a) c .f U O � � r NO N cc co a) Q. a) U > 0 o in cut I, --C U Q o aa. U- U U L En i O ' Q a) ca cu C3 o U vn a 2 ++ •V O E ca C: Q. o E o � v a) ) LL ''•L... ai m a) U tB a t w- _ O ca .0 ns i +_.. U U cu a) �«_ cu E L U U U O U!�— 0 U- 3 3 7 X 3 0 m CD wz LQ CD 'ZU � O U 0 C O �t Q � U ch p c� �a CU® ME a Q) in Vl �. Z 7.0 $ L C CD Cl) LLN � U CD O I.. U CL N (U C O CV a � � Q cc ..0 a N U a 3 IC) z U) W_ 0 Z _ 0 U Z Q H Z W m F- CL w 0 F - Z LL. C Board of Building Regulations Construction Suprvisor Licensetandards License: cS 60219 Birthdate: 4/27/1954 Expiration: 4/27/2009 Tr# 11766 Restriction: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of In vestigations 600 JVashington Street Roston, MA 02111 www.nrass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ant Information Name (Business/Organization/Individual): Address: City/State/Zip: I nch_e M S74 -- Print Phone #-. Are you an employer? Check the appropriate box: I am a employer with l�y 4- ❑ I am a general contractor and I employees (full and/or part-time)_* have hired the sub -contractors 2_ ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity - [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. (No workers' comp. insurance required.) t listed on the attached sheet - These sub -contractors have employees and have workers' comp. insurance) 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c- 152, § 1(4), and we have no employees. [No workers' comp- insurance required-] Type of project (required): 6. Q New construction 7. ❑ Remodeling 8- Q Demolition 9. Q Building addition 10.0 Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 'Any applicant that checks box #1 must also fill out the section below showing their workers eornpetisation policy infonnation- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contcacwm must submit anew affidavit indicating such 'Contractors that check this box must attached an additional shertshowing the name of the stab-conUzck rsand state whether or not those entities have employees- If the sub -contractors have employustheymust pmvidetheir workes'comp-pofteynumber I air an employer that is providing workers' compensation insurance for nay employees Below is the policy and job site information. Insurance Company Q / O Policy # or Self -ins. Lic. #: t�e- 7a 7 Expiration Date:w ^ 9— Job Site Address: City/state/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date) - Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties ofa- 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 $250-00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi oder the pains at enaltiesof perjury that the information provided abov /pis tr a acrd correct Swmilure: � / Daw- U�� _ Ido 1 -,iii City or -Town: Pct-mil/License 1`; Issuin- Authority (circle one): 1. Board of health 2. Building Departntent 3- Cily(Iown Clerk 4_ Electrical inspector S. Plumbing 11i -Sl c1or (.Other Contact Person: Phone #: 10/03/2006 15:39 7813584022 PETERSON -ACCOUNTING PAGE 02 ► 11.intFax 10/3/7,006 3:28 PM PAGE 2/003 Fax Gorvox ('11 .HE- Ames D4"TkGDA 01 ACORIA,. CERTIFICATE OF LIA13IL,ITY INSURANCE ANYREOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTNER DOCUMENT WITH RERI$iCTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR M AY PC R TA W,1FIt MISU RAN CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A1,1. T11E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ;Goy PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI In 9L Services Of MA, Inc. ONLY AND CONFERS NO RIGHTS UPON INS CGRMFICATr; 12 Gill Street Suite 5500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER -THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 4043 A Woburn, MA 01888,4043 INSURERS AFFORDING COVERAGE NAIC# INSURED INAIRFRA: St PAul Fire and Marina Insurance 24767 Peterson Party Center, Inc. NNBIRERB: North River Insurance Co. 99999 139 Swanton Street INSURER C Commerce & Industry Insurance Compan 19410 Winchester, MA 01890.1918 INSURER D: INSURER E: COVERAGES niE POLICIC S OF INSURnN It LISTED BF_I_Ow PI AVE BEEN ISSUED TO TNF INSURED NAMED A6011F FOR THE POLICY PERIOD INwrATFn. NOTWITHSTANDING ANYREOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTNER DOCUMENT WITH RERI$iCTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR M AY PC R TA W,1FIt MISU RAN CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A1,1. T11E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGRr_GATE LN ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INWRANCE POLICYRUMBER DA - LIN9TR A GENERALUABIUTY CK002IT138 16103/06 10103107 EA04 OCCURRENCE 31,000,000 x (Y.WW-Rt:W. nE3NWAL LIABILITY tt a Zama r-LAIMS MN7E T OUCUR L9f�NfIC WED CXPars wn $5.000 POWNAL B AoV KI1URY $1,000,001) VF -NERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES F45L PRODUCTS-CoMP/OP AGG s2,000,000 POLICY .I�FCT LOC A AUTOMOBILE UAEMU7Y ANY AUTO MA00200291 10/0.41`0$ - 10103/07 COMRINF,D BINMP LIAR 31,000,000 "act%4elv) bO01LY INAINiY $ r -P -A—) X, ALL ONNED AUTON NCHFOULEO AUTOS X X HIRr_0 AITW, NTN-C'1tNNFO AUTOF BODILY WJURY $ t) PI O"IM" DAMAGE $ noodbN) GAR/1C-LIARILITY AUTO CMY-FAACCEN34T 5 OTIEF3 THAN EAACC S nUTUUNLY: AGO $ ANYAUTO B EXCE88UMDRFLLA LIABILITY X C(=R ❑ CLAIMS MADE 5530892346 10103106 10103/07 EAC4 OCCURRENCE 35 000 000 AffWT-GATE $5.;()() 000 $ $ DFOUCTSLE _ X RFTFNTICN 3110,000 is WORKERSCOMPENSATON AND SINDERWC9687269 10/09108 10109/07 X IMG STATU• DIW EMP LUYFRQ•LIAR0.1Tr ANY PRO'RIETORIPARTNEP./EXECUTIVE E.L.EACHACMENT $500000 E.L. DISEASE -FA EMPLOYEE $300800 (FFICERWMBER EXALIDE07 It �1'� MWOft.n llnnly BP A PRCT/i9 IJ3 WOW _p 39 EL DISEASE -POLICY UMM 3900,004) OTHER DE"IPTION On OPERATION R I LOCATIOIO B I V08CLER I E;XCW MONS ADDED BY EHOOR ST:NPHT I SPEOAL PROM BIONS RE: Iniwred's operations renting equipment for buninam S social functionrti_'RTcluding erecting tents. SHOULD ANY OFTHEABOW DESCRIBED POLICIES DE CANCELLED BEFORVIHE EXPIRATION DATE TWEREOF, THE MSUIN0 I MURER WILL ENDEAVOR TOMANL j,D_ OATSWRITTPM MOTICL' TO THE CPFznFlGATE HOLDER NWNED TO THE LEFT, BUT FAILURE TO DO STI RHALL I MPO,RF' NO OALIOATION OR LIARLITY at ANY KING UPO.0 THE PISURER, I779 AGENTS OR Ac;cIRLI 2s(20m/08) t Of 2 #S1384941M138493 AGDCD o ACORD CORPORATION 1988