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HomeMy WebLinkAboutBuilding Permit #053-2011 - One High Street 2/13/2010 BUILDING PERMIT of "°RT#q TOWN OF NORTH ANDOVER 3? '`�° -'�*° APPLICATION FOR PLAN EXAMINATION Permit NO: '"�6 Date Received �9SSACHus�t Date Issued: �� /� ` I PORTANT: Applicant must complete all items on this page LonVz v->e LOCATION 6�0 V-Ki QMY�._�"�� OI Print PROPERTY OWNER M A-1nhuV 1 " v"if'�it VV)(f Vt+;!5 Print MAP NO: PARCEL: 0,/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes ` no . f TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: ommercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORME4: Identification Please Type or Print Clearly) OWNER: Name: SG= F:;t-i v lc; tyt k� Phone: Address: 1 © D vms- CONTRACTOR Name:`1 O.-J oa," 4 �.c>✓ t vV Phone: Co l7 S b 1 oSpo Address: (1,0 �G(�-- Vy\ A 07-1 64 Supervisor's Construction License: o 7 Exp. Date: 11 Home Improvement License: Exp. Date: 61 -fV\ e ARCHITECT/ENGINEER 0 iMaikvk 4kyMVvet AVLO one: 6k7 04517 Address: A 'Gfy-r-e-1- F,.)DsPV`I �AA 042-0 Reg. No. �32� FEE SCHEDU4BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 4y, n Z-,OU FEE: $ 4A 1 . 0Q Check No.: Receipt No.: -2-3 O�7 NOTE: Persons contracting with unregistered contractors do not have access to th aranty fund Signature of Agent/Owner Signature of contractor 77 ' BUILDING PERMIT O* pORTH q �tLlD 6 tiO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 4 Permit NO: - Date Received �/ 4,c 7 RgrEp 9 t ssgc►+us� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Agent/Owner - Signature of"contractor 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 COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 2010 Building Department artment 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:Building Permit Revised 2008 Location 'cA No. C3 .Lz y 2 6/i Date t �� i ,&ORTN TOWN OF NORTH ANDOVER F • O9 Certificate of Occupancy $ SSACHU Building/Frame Permit Fee $ 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2504 Building Inspector ORTH Town of o 'y No. ;s = /,� � �o LAK -O � dower, Mass., COCMICKEWICK 7� ORATED P'P�,`�5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic BUILDING INSPECTOR System > THIS CERTIFIES THAT C?'/!/,r v�� �d'if. ��s-�,�jc�ec.�..................................................... Foundation has permission to erect. ...................... buildings on ` l��ry ............................................................... Rough . ................... to be occupied as...... ..... .. � ��c-�Cr a/�c� .' / Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ................. ...... .. .. . .... ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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 j Smoke Det. � vjJ`' µoR711 TOWN OF NORTH ANDOVER oF,, kti '�pti OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover,Massachusetts 01845 D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION- SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 1, Carolyn Hendrie ,HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 1 High Street DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILD icD �yy CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING Building 14 , Selected Renovations to Floor 3 for G 4623 �' h Converse, Inc . TON, Z AUTHORIZED SIGNATURE: ��H DATE: July 7, 2010 REGISTRATION: 4823 NOTE: ENGINEER"WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Forni revised 11.15.2004 BOARD Or APPEALS 6880541 CONSERVATION 688-9530 11EAL'I'il 688-9540 PLANNING 688-95:.35 of goRY'k TOWN OF NORTH ANDOVER "�� OFFICE OF BUILDING DEPARTMENT �o *+ 400 Osgood Street �'� T,a.• `�y North Andover, Massachusetts 01845 9SSAC Mt`�� D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION- SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 1, Carolyn Hendrie ,HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 1 High Street DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILD 5�,.i'cD hit's• CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING C. Building 14 , Selected Renovations to Floor 3 for 1,{o.4fi23 Converse, Inc . TON, t AUTHORIZED SIGNATURE: or 0 DATE: July 7, 2010 REGISTRATION: 4823 NOTE: ENGINEER"WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Form revised 11.15.2004 BOARD Ol APPEAL.S 6880541 CONS ER\-ATION 688-9530 11EALT11 688-9540 PLANNING 688-9535 gORTN TOWN OF NORTH ANDOVER r d 4 PLo'•�°m OFFICE OF o p BUILDING DEPARTMENT �o *� 400 Osgood Street North Andover,Massachusetts 01845 �sS.�cHus�� D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION- SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 1, Carolyn Hendrie HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 1 High Street DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILD CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING- Building 14, Selected Renovations to Floor 3 for 10 r�No,4823 1;' Converse, Inc . - TON. AUTHORIZED SIGNATURE: �l��or IAAF DATE: July 7, 2010 REGISTRATION: 4823 NOTE: ENGINEER"WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Form revised 11.15.2004 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 I IEAL.TI-1688-9540 PLANNING 688-9535 ,AcoRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I6.. / 1 5/18/2010 PRODUCER Phone: 781-681-6656 Fax: 781-681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Driscoll Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 93 Longwater Circle HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 9120 Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Nat'1 Fire Ins Cc of Hartford 20478 J. Calnan & Associates, Inc. INSURER B:Continental Casualty Co. 20443 President' s Place, No.Tower 3 INSURER c:Everest National Insurance Cc 1250 Hancock Street Quincy MA 02169 INSURERD:Ohio Casualty Insurance Cc INSURERE:A[ner Int' 1 Spec Lines Ins. Co b6883 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 ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR 0 C DATE MM/DD DATE MMIDD A X GENERAL LIABILITY C2095325239 10/1/2009 10/1/2010 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $300, 000 CLAIMS MADE VIOCCUR MED EXP(Any one person) $ 5, 000 X Tnr- Cnntractual PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2, 000, 000 POLICY X PRO- LOC JECT B X AUTOMOBILE LIABILITY SAP2095325225 10/1/2009 10/1/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1, 000, 000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ 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 $ C X EXCESS/UMBRELLA LIABILITY 71C8000071-91 10/1/2009 10/1/2010 EACH OCCURRENCE $ 10, 000, 000 C X I OCCUR CLAIMS MADE Per Project Agg 10/1/2009 10/1/2010 AGGREGATE $10, 000, 000 DEDUCTIBLE $ X RETENTION $$10, 000 $ D AND EMPLOYERS'LIABILITY WORKERS COMPENSATION Y/N XWO S 3119 614 10/1/2009 10/1/2010 X TORY IIA IT OER � ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 5 0 0 0 0 0 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $5 0 Q 0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$5 0 Q 0 0 0 E OTHER CPPL8088097 10/1/2009 10/1/2010 Limit $1,000,000 Pollution and SIR $25,000 Professional DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of insurance for work performed within the Insureds scope of normal business operations. Notice of cancellation provision is 30 days, except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE *SAMPLE* CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U9 600 Washington Street Boston, NIA 02111 ivww.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Btisiness/Organization/Individual): J. Calnan & Associates, Inc . Address: 1250 Hancock Street, Suite 302N City/State/Zip: Quincy, MA 02169 Phone#: (617) 801-0200 Are you an employer?Check the appropriate box: Type of project(required): 1.MXi am a employer with 5 5 4. ❑ I ani a general contractor and i 6. ❑New construction employees(full and/or part-ti-me).* have hired the sub-contractors 2.❑ 1 ani a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for the in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ 5. We are a col.oration and its 10.El Electrical repairs or additions required.] ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. No workers' com right of exemption per MGL [ p 12.❑ Roof repairs insurance required.]t c. 152, S 1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#l 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I ant an employer that is providing workers'compensation instcran ce for my emp&gees. Below is the policy and job site itt formation. Insurance Company Name: Ohio Casualty Insurance Policy#or Self-ins.Lic.#: XWO5 3119 614 Expiration Date: 10 1/2 010 Job Site Address: ( `- City/State/Lip:_t,_ -y,�1vOf V 1�O1� � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requu•ed 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 tine Office of Investigations of the DiA for insurance coverage verification. 1 do hereby cerli& a the pains and penalties of perjury that the information provided above is trite and correct. Signature: f Date: fZ JOY ZQtO Phone#: 42�A] 3()L Off® Official itse only. Do not write in this area,to be completed by city or town offrciul. City or Town: Permit(License# Issuing Authority(circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. Other Contact Person: Phone#: Massachusetts - Department of Public Safrn Beard of Buildin- Re-Ulations and Standards �-! Construction Supervisor License License: CS 56087 Restricted to: 00 STEPHEN M TERRENZI 12 ENDICOTT STREET �` ► NORWOOD, MA 02062 Expiration: 3!512011 t unmii��i!mtr Tr#: 12500 •