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HomeMy WebLinkAboutBuilding Permit #Exception - 10 INGLEWOOD STREET 5/1/2018 4 ro"N OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SSACNUSE4 Permit \O: Date Received: Date 13SUCCI: IMPORTANT: Applicant must cirmplete all items on this page I LOCATION_ I, u kj L-,L-e woc,D Ag CLc%r I'r i r PROPERTY MVNER. MA TheAA Print %1AP NO.: PARCEL: 1.5 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 -TYPE OF INIPRO� ENIENT PROPOSED USE Residential ( -- - -- Non- Residential i )'Q'tiew..Building i One family _J _. addition = Two or snore family I � -- Industrial Alteration I No ofunits: _. Repair, replacement _ ,lssessory Bldg, _ i ;-. Commercial l Demolition a --- ------- -r — Moving(relocation) Other Others: ! Foundation only — _ DESCRIPTION OF A,ORK TO BE PREFORMED Identification Please 'f e r Print Clearly) OWN, ER: Name: MA V1W,,1 Phone: tii nature ° -_.- Address: `7LI, ''t Le Si', -.IV. � 6 Vet' Mg o184s C( NTR,kC`I"GR-:game: 3-. x.1011 ;— l i c Address: � O S OX 13'2- A x Supervisor's Construction License: CS 06 303 IG _Exp. Date: r+—,"11C lt?lC)1''.1�,Ct7ll It i..iCi11S�:_ 13-7 -S(vA ,'cis!rc.•��s: `Z� ��1�,�' t'1't? ! ,vr�pJ�- ;2t :�, ' F-6ESC'HEDULE*:3t M.'T:G�'FYJI1T:.''10.00 PER 51000.00 OF 1'1JE TOT 1L EST1.V-4 TED(0,s7'3,'A-D 01% r?s•00 PER S.F. freta Project C'{_,a (_'hcc . k N� I �. j TYPE OF SE\X.\RGE DISPOSAL I St4lnlnlln�, Pools Tanning;\vlassagc Bod) An Public Serer - Tobacco Sales - Food Packaging.Sales Well Permanent Dunipster on Site Private(septic tank,etc. NOTE: Persons contracting; with unregistered c•Onlruc/Ors(l(►not have access to the quurmi(y funJ tit nature oCAgt nt )wner Y� �� i Signature of Contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED �-�- PLANNING & DEVELOPMENT ' i-Water Shed Special Permit ILJ Site Plan Special Permit 1-71 Other COMMENTS DATE REJECTED D�TE APPRO� D CONSERVATION . J �✓/ I 1 J COMMENTS__/ ��--co.� r�-�,o� /k ,n d a i�S OK - d !; DA TE REJECTED DATE APPROVED HEALTH COMMENTS /onin.! Board of;\jipeals: \ariance. Petition ! /on im_ Decision.receipt submitted yes-- _-- Pl:irutin Board Dccisiim: C;n?menu 1_'::ns�r�aticn i.)ccisi��tr. C�;ntmcnls - '�ate: 5cr�cr cl:nnection':tunaturc it date em Dunt ter im sate esument i�n lttue ilatcv. p p'` � no Fire De . t -- --- p ----- --- - ----- -- 'Z y"1 -� BUIldinLI N�rtYtit ,approved and lssttcd h-, _ _--^— Building Setback (ft.) Front Yard Side Yard Rear Yard Requited Prok ided RcqUircd ProNides Required ProN ided -Z 0 DENIENSION Number of Stories: 34 Total square feet of floor area, based on Exterior cl i I jell,ic,lis._A I AA Total land area, sq. ft.: OO C) do I F'S and DA I'A -(1-or k.1cliartnictit use) . ......... 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 a Building Permit Application Debris Removal Form Workers Comp Affidavit Photo Copy Of H.I.C. And,'Or C.S.L. Licenses a Copy of Contract Floor Plan Or Proposed Interior NN'ork :addition Or Decks :i Building Permit Application Form U .j Surveyed Plot Plan A Debris Removal Form a Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses Copy. Of Contract j Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And I-lydraulia Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) .t Building Permit Application Form U j Certified Proposed Plot_Plan a Photo of H.I.C. And C.S.L. Licenses 1 j Workers Comp Affidavit j Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydrau Calculations (If Applicable) :j Copy of Contract `class check Enc:rag, Comply--macc R,-,port If all ta.ies lE a 'k 11i'Ia11ce+i l'special Ell's°il9( pile I m,) 4_!ca'I<ti .i;Ei+..t lt.l5a %:li'elp _!!�'^'c..;++)fl from `ht :3oard 'A a als lw( the 'iipeal pericd '.s+)w Fir. Pv:lpplicallt.'lme.t Ole)) ,,rt !his '@tc rz,•.�i t,•y ::E'"a:('SEs. ')ae a:= EIM1 aaad ?' �cordialn -mv5t lie s0mlittF 4d ~with Mac haaildi€l<Y lnplic:ltil)al '•`4'F( !iai'\"I.:TR.w;([t.1AP).R`'?h-`•'I`3f f::}[(,a•1> ACORDM CERTIFICATE OF LIABILITY INSURANCE 04/12/200) PRODUCER (978)374-6352 FAX (978)S21-S127 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION COSTELLO INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2 South Kimball St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 5248 Bradford, MA 01835 INSURERS AFFORDING COVERAGE NAIC# INSURED Quinlan & Rand Contractors INSURERA: National Grange Mutual Ins. Co 14788 34 Trinity Court INSURER B: No Andover, MA 01945 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 DD'TR INqR TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICMM/DD[YY1 DATEY EXPIRATION LIMITS GENERAL LIABILITY MPS73609 03/12/2007 03/12/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,000 A 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 7 PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 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 EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—]CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC YS LAT0TH- EMPLOYERS'LIABILITY TIM ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-.EA EMPLOYE $ 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 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 'Town of North 'Andover OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. N. Andover,. MA AUTHORIZED REPRESENTATIVE William Costello ACORD 25(2001%08) ©ACORD CORPORATION 1988