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HomeMy WebLinkAboutBuilding Permit #286-16 - 10 WOODRIDGE DRIVE 5/1/2018 NORTH BUILDING PERMIT o�t�LEo 6q't'o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION e mh Permit No#: Date Received 3y'�4ArED P-Pp�4`� SSgcHos� Date Issued: /II,,MPORTANT: Applicant must complete all items on this page LOCATION r I Print PROPERTY OWNER ` - Print 100 Year Structure yes no MAP 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 E�Areration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - _ —_ _ 0 Septic 01Nelf ❑ Floodplain{ F D=Wetl'antls ❑ UVatershed Distnet __Water/Sewer - =' ----_ ---------- DESCRIPTION OF WORK TO BE PERFORMED: Igo Iden ificat71' Please Type or Print Clearly /�OWNER: Name: � � � Phone:"i�� G� � Address: Contractor Nay10A, t�. �j Phone: Email: � OC11CO vV7 Address' l vp r ►r►n cy Supervisor's Construction License: C 00( '6)- Exp. Date: 10 41)� Home Improvement License: Exp. Date: 3 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. 00 Total Project Cost: $ S0_0r FEE: $ f a Check No.: �/ 2 Receipt No.: �s NOTE: Persons contracting with unregistered contractors do not have access to the ranty fund 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 m D FORM PLANNING a& DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Siqnature COMMENTS t 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 ^�" p R FIRE DE �RTMENT p �11q � �` - rio `.. PA a Tem Dempster on site, ye "Y> Y� 4, x Lo ated Al 124 Main Street `* _e•+.e°'t �..e+.F•,in�.a.-«� "dC'.� ...*0..?rct � r �'�.r `f �x' '� u �d'� T� '� s #' r. a� �_ } F.i-re Department 7 ... yy �.•.� y �, 9k 1 .4'y �.a�#�.. ,gti�,e�w. v�.+ i s » ��•`t QCs.. , e` '..aA,tJ -y.� .•.. �.lew,-e .t_a...ar w,..o- ,...�.:....�.,:.i._..,.........si°--'^.._�:[-..�a`_es..�-s 's.�`e-;:.,._..r�mF1.y•+.1��i`...-�. �r..�...+ �.....:..�,Y��ar�s, -.r 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) i ® Notified for pickup Call Email £ 3 Date Time Contact Name 3 Doc.Building Pennit Revised 2014 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 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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/Cross Section/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 OTE: 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) 4. Copy of Contract 4- 2012 IECC Energy code 4 Engineering Affidavits for Engineered products OTE: 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 2014 Location f No. h�" Date � . - TOWN OF NORTH ANDOVER w Certificate of Occupancy $ Building/Frame Permit Fee ,ks Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#' 0-5 i ` Building Inspector NORTkf own of t E ndover O - 0 No. h ver, Mass, COCNICNl W#Cu 01#A TIE D U s BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �! dV BUILDING INSPECTOR THIS CERTIFIES THAT ...........�'�/® ..`/..�:�??rs ... ................ .... .�.. ... ...................... ......................... oe�- Foundation has permission to erect .......................... buildings on C .!�l. .... . .............................. / Rough �. '"^ D/J'!F G� k111Ja C ............................................. Chimney to be occupied as ................ fje!?s....G.'. . .............................. ...... .o? .: v provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 ........... ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. ---� OP ID:COHA ACORO® DD/YYYY) TE(MM/ CERTIFICATE OF LIABILITY INSURANCE DATE 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS 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 endorsement(s). CONTACT PRODUCER Phone:978-688-6921 NAME: Hannah Courtemanche,AAI,CISR Macdonald&Pangione InsuranceFax:978-688-5350 PHONE 978-688-6921 FAA/c No:978-688-5350 P.O.BOX 428 AIC No Ext 104 Main Street E-MAIL m hannah ins.net North Andover,MA 01845 ADDRESS:hannah@mpins.net DGCON-1 Donald Schemack cusroMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting, Inc ID 646648 INSURER A:Travelers Prop&Casualty CL - 25674 - 428 Pleasant St INSURER B:Safety Insurance Company 39454 North Andover,MA 01845 INSURER c:National Liability&Fire Ins INSURER D: INSURER E: INSURER F: - COVERAGES 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 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. INSRLTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM/DDS POLICY EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 680-1553818 05/17/2015 05/17/2016 PREMISESEa occurrence) $ 300,00 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - 1,000,00 - (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 3116538 07/12/2015 07/12/2016 PROPERTY DAMAGE - X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 - EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 A CUP-0090153321 05/17/2015 05/17/2016 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMITS ER YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE9WC640862 03/31/2015 03/31/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DYSCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 36 Bartlet St Andover,MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD t CS-0018'I 128 PLEASANT ST r AKDOVER MA 0191 1t ` �"