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HomeMy WebLinkAboutBuilding Permit #217 - Main St - 396 9/19/2007 ISUILUIN%3 rr=r%lvll r t -. TOWN OF.NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received SSACHusE��� Date Issued: .Q IMPORTANT:Ap licant must complete all items on this page � f TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family 0 Industrial Iteration No. of units:�',1�, c [I Commercial Repair, replacement ❑ Assessory Bldg [I Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address w t 1 21191, f r v w ARCH ITECT/ENGINEE 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. Total Project Cost: $ 2 Ll I'1 h FEE: $_ Check No.: s� Receipt No.: 0?0 NOTE: Persons contracting with un•egist red contractors do not have access to the guaranty fund ,ww ..a . �.rr�cv,.kw4e5.u::,.»sawu,>S+� Me n n wK . . 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 - F71 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &-DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ El 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 '�' '� m��.:ry> "�i r"j�' 'i"{�,�`�w��✓ '�,V�#yam"�r6�;' s�" "-w t r�� ' —W4^G�ir.113�`�(�W. ,�.'"a' ,7 �a'.��1x `«� zTA hR 34 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 i� betn 1 v" ❑ Notified for pickup - Date —._................. Doc.Building Permit Revised 2007 _ 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 o Building Permit Application ❑ Workers Comp Affidavit El ete-Ge 0 H.I.C. And/Or C.S.L. Licensesf/ K�''" opy of Contract Elr-�'IOr roposed Interior WorkIf ❑ nglneere roducts NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses L3 Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit was required the Town Clerks office must stamp In all cases If a variance or special permit q P 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 i Location.D&l2 No. �� DateOf "/ 6 MORT� TOWN OF NORTH ANDOVER OL - � 9 + Certificate of Occupancy $ t <� Buildin /Frame Permit Fee $ � s�cNBuilding/Frame Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �6-/ 20613 Building Inspector Town NORTH of TO_ No. Z -_ _ 7 _ * , - �]`( �, do , dover, Mass., T Q -- LAKE I. COC M ICMEWICK V DRATED '9S BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .f)&U..4v. .........C.61.... ..... .... ............. ................................................................ Foundation has permission to erect........................................ buildings on ....34.. .........�&AN. ....... ... ....... r................. Rough t0 be Occupied as... !p...���lM�!T.. l. �.w��...�.......�+ �................... .... �. 1 Chimney 11..... e provided that the person accepting this permit shall in every respect conform to the terms of the a p ication on file in Final 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 D ,tT Final Q�1'00� PERMIT EXPIRES IN C MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. PROPOSAL 5ruf� •rvAr.�r!' �.�rr� �.,�;,tl��teai PROPOSAL NO. . t� /� �© ' iOC, 6OX 770 ti h 12 J �I�r� �� SHEET NO. DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS £, . ADDRES / t=tri a 7- A f DATE OF PLANS PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of f..5 Ac "o y ` yrs, ,[ f _/ j. s #i L .T j r r.Y., .� Y✓ f < ,,i -e:. l # +�.a c" f y e-f > t f �( ek(/ f.&. C Ct i f'L� rr r plc (? ` e7irt s� ft a. 5iey fur f' y-� 1 / t ' W' ? ' 31/ L.t/ `t I/_j'. W;1ej'a4' 1. / J2 '" '- ' � ��'F A '�V ( '1 1 e..h/C%✓S TYi'Y! /PiJ^I'Sf:.. A5 4122.1-4L D t4'17,1 4*1,�^ rt' Lh7 !s ,r,• /* . Q i;"�_ c r e p mvk All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of w,..f r/ v f ' ffill- , � f=t :',c Dollars ($ with payments to be made as follows. 5";j rj �t? q{'. ef 40# , - j p KU ; , C", r�, `r 1 n Respectfully submitted Any alteration or deviation from above specifications involving extra costs ty/ I' will be executed only upon written order, and will become an extra charge' !.p_r rltaAf d over and above the estimate. All agreements contingent upon strikes, ac- cidents,or deiays beyond our control. Note—This proposal may be withdrawn l by us if not accepted within days. I ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted, You are authorized to do the work as specified. Payments will be made as outlined above. Signature f i E Date !} o- Signature ;eda— NC 3818-50 PROPOSAL i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 M s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): r(,U,1 S�Ci ej d1oy Address: 0- Go)( `S^7� �— City/State/Zip: P�q pq e �2.4 (C W a Ut/0-6hone #: �'-D7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.2I am a sole proprietor or partner- listed on the attached sheet. t Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] fi employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: 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 of MGL c. 152 can lead to the imposition of criminal penalties of 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. 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: i2, ( — / -a 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#: DATE Qom, CERTIFICATE OF LIABILITY INSURANCE 09/14/2007) PRODUCER (207)985-2941 FAX (207)985-3122 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Morris Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 770 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Kennebunk, ME 04043 INSURERS AFFORDING COVERAGE NAIC# INSURED Brian Staid INSURERA: NGM Insurance Company 14788 104 Orchard Road INSURER B: Cumberland, ME 04021 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSREGENERAL LIABILITY MPJ0855C 06/27/2007 06/27/2008 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY 1311345233 07/20/2007 07/20/2008 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO S00,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- 0TH- WORKERS COMPENSATION AND I TOYLIMI EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY St Paul 's Episcopal Church OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. N Andover, MA AUTHORIZED REPRESENTATIVE 11(imberly Whitmore CPCU/KW ACORD 26(2001108) ©ACORD CORPORATION 1988 - c --- -- ----_...----- 195" V ►+ --81 — '----- } 33" S 39,"' 15" �� 24.. O I � O l I -243 38"----ii 124' '6'} 34" 38" 42" J I l 81 �r 1L" 24—"._...... --33"4" 18" —� 26; ! i 1 OO 114. -' WQy.V1530FF WC 2430R P16ES (Apl Lo y N `I IBD31 24.DISHWLJ SB33OTOST BWT18 - l II _............. .. . _______.___..._____ co ' • � ; a rN CEILING HEIGHT--102" �� i U) wo ! lA 00 y` HEIGHT-TO PIPES--92 1/2" i r l p HANGING HEIGHT--84' I CROWN MOULDING ABOVE C; H 4 l r MERILLAT DELUXE CABINETS C ! SENEGA RIDGE SQUARE DOOR _ j( o 3 i MAPLE WITH NATURAL FINISHCr m KNOBS-HK01 WHITE CERAMIC KNOB \-) SQUARE EDGE COUNTERTOPS l WITH LOOSE BACKSPLASHC REFRIGERATOR SPACE i I WILSON ART 4651-60 NAW LEGACY 36"WIDE;72"HIGH = 32"DE P BOXC. REP3296 REP3296 \' \ _..........._...__. - I o BSD36DT- W362412 i H O ---- I (D m W3630 I WALL CABINET ' a) cn /' ,•\ 59a" - { 36" 36" 61y."_ O 0) k--40" 1353" 59a" �=-36" 36" fits" 195" i ` All dimensions .size designations given are MAEVE CULLEN CKD This is an original design and must not be Designed: 8/9/2007 subject to verification on job site and .JACKSON LUMBER released or copied unless applicable fee has Printed: 8/10/2007 � adjustment to f t job conditions. been paid or job order placed_ rV i ST. PAUL'S RECTORY#2 A11 Drawing #: 1 Scale : 0 5/16" _ 1'