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HomeMy WebLinkAboutBuilding Permit #145 - 10 MAIN STREET 8/24/2006 i ! TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o "��T 6�tio 3? , 0 ° ;_ 'A �— Permit NO: Date Received / �9SSToo Date Issued: � 6 4 AIC14US���S II IMPORTANT: Applicant must complete all items on this page A '( LOCATION i O MAIN S N �J n PROPERTY OWNER O Pri t MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ation No. of units: ❑ Repair, replacement ❑Assessory Bldg (;�mercial ❑ Demolition c ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DDCRIPTION OF WORK TO BE PREF RMED 1 x "—Guy) eL;t.eF?/-le e i ,c�c��� ' 2—k,5 aAWW 4c)/7-/- -;-u d P cx�P-5 6u4//S DooPS ;',Arne J & P.414 e.) Identification P(ease/Type or Print Clearly) OWNER: Name: V �<(R N'Ne t�j Phone: QUA QV 11 i UL MA ©�8 30 Address: 34 t� �� CONTRACTOR Name:- ' E�ji e e p i s(2 `J Phone: � ��— toy , Address: : ® o� 50 d-J Q C.� IMS#r r2 vJ ( 011?6 3 Supervisor's Construction License: ��✓� �/ Exp. Date: Home Improvement License:13%02 9Exp. Date: 6"30 ®� ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 2!/Q FEE:$ Check No.:� d Receipt No.: Page I of 4 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) 1 I ❑ 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 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:BPFORM05 Noe 4 44 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer L+7 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ElPermanent Meter location to project NOTE: Persons contracting w' nregist red contractors do not have access to t7St Signature of Agent/O er Signature of contrac Plans Submitted Plan Waived ❑ Certified Plot Plan ❑ ' s ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ COMMENTS Other DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes_no Fire Department signature/date Pane 4 of 4 Building Setback (ft.) Front Yard Required ProvidedSide Yard Re wired Rear Yard Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For de artment use) 1 f 1 11 I Page 3 of Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 i Location M No. fy S Date NORTH TOWN OF NORTH ANDOVER Oj ° • OAL 41 ' Certificate of Occupancy $ 1'1 S��nO'Eta Building/Frame Permit Fee $ a. Mus Foundation Permit Fee $ Other Permit Fee $ 4+ TOTAL $ l; Check # � LY; 1 951 4 F M' _:. Building Inspector tZ. Q o � IL - 7ri i _ „ c ,h-C CONTRACTORS INVOICE WORK PERFORMED AT: To .J kol �t DATE YOUR WORK ORDER N OUR BID NO. 4 A-141 ,Slrfi�r��r+` /r SI/��? ""�C✓ � � , ,chi,» .r✓'"C 0 ul, , �? �� c3 , 3rd �►' /v.5 /V 7' is, Z4&te 4W1"oA.,'C E . ✓�t F i`. 3t d` { All Material is guaranteed to be as specified, Mid the above work was performed in accordance with the drawings and specifications Int provided for the above work, and was completed in a substantial workmanlike manner for the agreed sum of i Dollars($ / ). a _ � 1 This is a LJ Partial El Full invoice due and payable by: Month Day Year i in accordance with ourA©"g eement ❑ Proposal No. Dated Month Day Year MADE IN USA CONTRACTORS INVOICE ' N RTM Town of Andover -M No. lq ' O 0 1 � _ Z - 2� • 0<0 LA o = dover, Mass., C OCHIC MEWICK ��A0RgreP'? (cl BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......�'cdXW,.......Tr.!..P..o...b.—l-A....................................................................... Foundation has permission to erect........................................ buildings on ....to........ �. . ..........r............................... Rough to be occupied as..... .,..�, W 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 CONSTRtJCTTFSARTRough ....... .......... Service BUILDING TOR Final Occupancy Permit Required to Occupy wilding 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. •_ .� ✓fie -+°o7runwnu�ec�,�t o���aactivaelta Board of Building Regulations and StandardsE HOME IMPROVEMENT CONTRACTOR Registrabon::,:131299 Expiration .fi/30/2008 Type DBA DCT ENTERPRISES ANTHONY WHITVNAY*1 304 PONDVIEW TYNGSBORO,MA 01879 Deputy Administrator ✓/ze �omr�maizureaCC/ o��ac�iuoela BOARD OF BUILDING REGULATIONS License. CONSTRUCTION SUPERVISOR NumbeY_Aa-S 090891 9 /1955 i cp .5- 0202008 Tr.no: 90891 REs�� ANTHONY WFiIfiMAmf 304 PONOVIEW P TYNGSBORO, MA 0187 Commissioner � I ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) D&TEN-1 08/22/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Westford Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 187 Littleton Rd P.O. Box 308 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Westford MA 01886- Phone: 978-692-3073 Fax:978-692-0429 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Preferred Mutual 15024 INSURER B: D&T Enterprises INSURER C: PO BOX 50INSURER D: North Chelmsford MA 01863 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. 1NDD'LPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD/YY DATE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE $ 500000 A X COMMERCIAL GENERAL LIABILITY CPP0100584842 12/20/05- 12/20/06 PREMIASES(EEaaEocccuence) $ 100000 CLAIMS MADE X❑ OCCURMED EXP(Any one person) $ 5000 r` PERSONAL&ADV INJURY $ 500000 GENERAL AGGREGATE $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000000 POLICY PRO LOC JECT 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 OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ i OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION NORTHAM 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 DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood Street North Andover MA - REPRESENTATIVES. AUTHORI EPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988