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HomeMy WebLinkAboutBuilding Permit #798-12 - 10 SALEM STREET 5/3/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: ��' Date Received Date Issued: - IMPOR/TANT:A licant must complete all items on this page LOCATION /� Print PROPERTY OWNER 1 i i7 Z iP� �y i,�os 'Pie ka Aw Unit# Print MAP NO:IPO ARCEL: ZONING DISTRICT: Historic District es no Machine Shop Village yes no 100 year-old structure 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 ;efR pair, replacement ❑Assessory Bldg ❑ Others: Zemolition ❑ Other - ®�ptc -0}Well DF oodpla '®Wdfl'an�ds ® `We Distract µi 1 a ESCRIPTION OF WORK TO BE PERFORMED: eHsO I x;f �a G S 64 le S/ "/r?S06 . fli t• D oo C &,054 SPS . i (Identification Please Type or Print Clearly) OWNER: Name: 0_i 6Zle*lly %RIS /'- -061 1QJ Aiyallez Phone: 60cl-3 R9-V"0 Address: APeA CONTRACTOR Name: j�f ',, Phone: 6'oc$-3. yr63 a Address: !��1 ©.l�l%``�96�1� i /(/v �.��oye�2, h1,,p- -- Supervisor's Construction License: �% 7S'_;0,:?._ Exp. Date: /A/Y,av/� Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �/ Phone: Address: Reg. No. - - 1 FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_�7., FEE: $ 4/ 6D Check No.: 836Receipt No.: _� NOTE: Persons contr ing with un�istered ontractors do of Dave access to the uaranty fund t _ _ - -- -� - - -- - -t-- ,Slgnatur ;of#A'gent/Own rr � r� �Sgnature,o e,, ; 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL I 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 'I INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature k COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connection/ 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 2011 June/mi 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 of4+ -tAnd/Or C.S.L. Licenses j Li 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 { Li 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 L3 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 o 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: Doc.Building Permit Revised 2008mi NORTly Town of 0 No. T lit LA E0 dover, Mass. O COCHIC EWICK �t ADRATE D PPF`��,�5 S BOARD OF HEALTH Food/Kitchen Septic System PERMIT TBUILDING INSPECTOR THISCERTIFIES THAT.... ................................. .............................................................................................................. Foundation 4� s' has permission to erect........................................ buildings on ./ ..................... ...................................................... Rough Chimney to be occupied as. �, ���6 e o 0 .......`....`.. ........... «�.................. e s o�� f �s ............................�. ..�....................fir........................... .... 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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 (Mall To Be Done FIRE-DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 6 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/2'/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS.CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - IMPIORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemeri PRODUCER CUNIACT NAME: _ _ M P ROBERTS INS AGCY INC AICNo Ext: (978) 683-8073 (ac,No):4978?683-311_7 l 1060 Osgood Street ADDRESS:Mike@mprober'tsinsurance.aom North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE ---` NAiC0 INSURER A: INS_ ED CENTER REALTY TRUST INSURER B: INSURER C: F P.O. BOX 876 INSURER D: ZURICH NORTH ANDOVER, MA 01845 INSURER E: INSURER F: gVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 I 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ L-MTTYPE OF INSURANCE IN8111 y,ND POLICY NUMBER (MMIDO/YYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S . COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) S 1_ c I CLAIMS-MADE I OCCUR MED EXP(Anyone person) S a 1_ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ r k GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ I h POLICY L1ECT 0 LOC ..�� g 1 `I AUTOMOBILE LIABILITY Ea strident $ 6 ANYAUTO BODILY INJURY(Per oerson) $ -C ALLOWNEO - SCHEDULED BODILY INJURY(Per accident) S {P F` AUTOS AUTOS NON-ONMEDPROPERTY—UAITWAUff-- HIRED AUTOS AUTOS (Per accident) + UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB ' i CLAIMS-MADE AGGREGATE $ i Y CED RETENTION $ $ + f'-NdRKERS COMPENSATIONTA OT ) 1 AND EMPLOYERS'LIABILITY C X TORY LIMITS ER n !� ANY PROPRIETORMARTNERIEXECUTNE YIN NIA WCOOS095106 02�10�12 02�10�13 E.L.EACH ACCIDENT S 500,000 i. CFFICERM,EMBER EXCLUDED? ❑ tIMandatoryInNH) .. E.L.DISEASE-EAEMPLOYEE $ 500,000 +If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 50-01900 1 �• S 6. &I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it mon;apace is required) 1 F CERTiFiCATE HOLDER CANCELLATION SAMPLE 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Y . ©1988-2010 ACORD CORPORATION.All rights reser,�ed. ACCRD25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts- tDepai-trnent of Public Safetc ' Board of Building,:Retrulation.s and Standards Construction Supervisor License - I License: Cs 75302 tl 4 s I BENJAMIN C OSGOOD Y 69 OLD VILLAGE LANE NO ANDOVER, MA 01845 i Expiration: 12/4/2012 ('ununisiuner Tr#: 6267 —- r` Location No. / Date • - TOWN OF NORTH ANDOVER • �y 'ILI"s731j�4�` � • e .- Certificate of Occupancy $ s Building/Frame Permit Fee $ ��i� '90 M1Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# 25263 Buildi g Inspector