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Home My WebLink AboutBuilding Permit #591 - 100 SALEM STREET 3/24/2006 otNooT°dry � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 9SSACHl1`'Et Permit NO: Date Received: `Z7 OG Date Issued: - O IMPORTANT: Applicant must complete all items on this page LOCATION d S,4 L P r, ` S I' _ _ Print PROPERTY OWNER 8 M ?f u►7,F Print (� MAP NO.:�_PARCEL: �� ZONING DISTRICT: (C "3 0 4 0 f6 P a TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ew Building ❑One family ❑Addition ❑ Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair, replacement ❑Assessory Bldg ❑ Commercial ❑ Demolition + ❑Moving(relocation) 701t-her SC1pM M 1A)C, ❑ Others: 1 ❑Foundation only I DESCRIPTION OF WORK TO BE PREFORMED { XqJ i St.,sIM M IP(r' L 1 , Identification Please Type or Print Clearly) IM ?A-T ��f-�1 769 OWNER: Name: 1 OM /�1�'�4u Phone: Signature Address: Ldd SiLfAA 4606&/l /M CONTRACTOR Name:�1ifiz/LA2 J��oLS �i'tSd°� tQ 040 Phone: � Address: 35 m f Lt MA LROW D M A d / 71-�k Supervisor's Construction License: 0log 3 917 Exp. Date: Home Improvement License: 1 ;2 3 40 Exp. Date: c�,/3 -`2` o 7 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$725.00 PER S.F. Total Project Cost :$ d2 5 d 4c3 = d o x10.00=FEE:$ 250.00 t No.: �® Check No.: �a�t� d 's Receipt Page t of 4 x it r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i 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 E ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan l ❑ Photo of H.I.C. And C.S.L. Licenses j ❑ Workers Comp Affidavit i ' ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan An 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 I Page 4 of 4 �1 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I NOTE: Persons contracts sth unregsste contractors do not have access to the guar fund Signature of Agent/Owner Signature of Contractor Plans Submitted L+�' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑'� � THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM . 1 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ V-3- ' 14-0(4 COMMENTS DATE REJECTED DATE APPROVED HEA-LTH ❑ ❑ C T\4 a. .oning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date I Temp Dumpster on site yes no_ Fire Department signature/date I Building Permit Approved and Issued by: Page 2 of 4 I Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided i I DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) I� Page 3 of 4 I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 li 9 F , Location 1 oo lei ,F r No. Date s MORTq TOWN OF NORTH ANDOVER # Certificate of Occupancy $ NuBuilding/Frame Permit Fee $ '� sncsE Foundation Permit Fee $ Other Permit Fee $ Cry TOTAL $ Check # 19049 Glee- 667%) Building Inspector ACOR_D„ CERTIFICATE OF LIABILITY INSURANCE OP ID T DATE(MMIDD/YYYY) DEVIN-2 � 03/18/05 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: Central Insurance Company INSURER B: David Devincentis DBA -- - - - -- - Devincentis Electric INSURER C: 20 East Prescott Street INSURER 0: Westford MA 01B86 --__..._---- --- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEIJ ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. 1RSR ,. .-------_.._._._...--------...—.- --------- ---- EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE YMM/DD/YY EFFECTIVE PDATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X�COMMERCIAL GENERAL LIABILITY 7919611 03/17/05 03/17/06 PREM i's ES(Eaoccurence) $ 100000 CLAIMS MAGE I X I OCCUR MED EXP(Any one person) $ 5000 I.. ._ ..._..__ -- -- PERSONALBADVINJURY $ 1000000__ GENERAL AGGREGATE js2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2000000 POLICY PRO- JECT - LOC - — - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) -- ALL OWNED AUTOS I BODILY INJURY SCHEDULED AUTOS i (Per person) $ HIRED AUTOS — BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE - I $ (Per accident) GARAGE LIABILITY i AUTO ONLY-EA ACCIDENT $ ANY AUTO --- OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR -I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ j RETENTION $ $ WORKERS COMPENSATION AND wCS I I TORY LIMITS EMPLOYERS'LIABILITY AN. PROPRIETOR/PARTNER/EXLCUI'iVE E.L.F.ACH ACCIDENT g OFFICER/MEMBER EXCLUDED? I E.L.DISEASE-EA EMPLOYEE $ -- If yes,describe under _ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Electrician - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Ferrari Pools i NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 467 South 'S treet IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Marlboro MA 01752 REPRESENTATIVES, AUTHORIZED REP712SENTATIVE Tracy Half ACORD 25(2001%08) % f ©ACORD CORPORATION 1988 r r u u o G u u J l o: u-r n r L n A C R o C l r n n r I i I i I . I I I i 1 e COMONWEALTH OF MA$SACHUSET�TS DIVI!:,10fl OF PROFFI-,SIONAL LICENSURE iAS A �t G -it)U��YMAN�ELECTkI 'I ISSUES THIS LICENSE TO ' 3 DAVID A rjk%rxn��fwTIS I IL 2 4BS C tl B f:L .N"IL'L 'RA I MIAg0N ! 14H 0 048-490 2974 E D7i31/07 . 070611 f CEO'MM WEAL 'F# M, 6P§#CHU ETS St Mff (JF E L E 0 t A I AN R�GXSTEF ED MASTER: . ELECTRICIA. ISSUES THIS LICENSE TO ' D�VINCE T ElEC7R'IC bAVID A up,. INC •N TIS 435 CAH BELL (RILL RD f i MASON NH 03048-4903 12838 07,31/07 070612 umcm_. i NORTH _ Townof 4Andover O 110. YO CA O dover, Mass., ` COC M I C ME WICK 1• I� V 7 ADRATED PPS` �y �S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D "ORBUILDING INSPECTOR THIS CERTIFIES THAT......... rjonv.....pq4tv%...4a 11&....................................................................... Foundation has permission to erect........................................ buildings on......I.Q.0..........SALCL. ...........&�... Rough to be occupied as.2�.. .. .C�........,S�,.i.��l�n.inn.`i!l... ...... ..G-L.......................................... Chimney .. . ... provided that the person accepting this permit shall in every respect comorm b 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 CONSTRUCTISTART Rough Service BUI SECTOR 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 Smoke Det. /reons.7�w�uueall/r o fl�ad�ac.luveCta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069397 Birthdate: 06/05/1964 Expires: 06/05/2006 Tr.no: 26602 r' Restricted: 00 JASON E WARD 4:,ACORN PATH c GROTON, MA 01450 Commissioner i 9Xe -� Board of Building Regulations and Standards a - One Ashburton Place - Room 1301 Boston. Masc{husetts 02108 Home Improvement tractor Registration Registration: 123408 Type: Private Corporation Expiration: 2/13/2007 \.1 FERRARI POOLS & PATIOS, IN == =. JASON WARD 35 Mill St. Centeral MARBOROUGH MA 01752 ! i _ , � : Update Address and return card.Mark reason for change. DPS-CAI 0 5OM-04/04-G101216 a � Address Renewal E] Employment f'� Lost Card I 1 �I 1 r rhVIVI IlI I IhtUUt IIVJUHANI t kIHU) tt0 Z ZUUO IZ:U�/JI. I'L:UI/NU• 6SlUU5Ulti( f Z AGOHD„ titK I If-JUA I C Vr LIAWLI I Y INOUKANVt FEuXW5 02/02/06- PRODUCE., THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 155B Otis St. , P.O. Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northboro MA 01532 Phone: 508-393-7744 Fax:508-393-6983 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A; Acadia Insurance CO an INSURER B: Ferrari Poole and Patios, Inc. INSURER C; _ Ferrari Full Circle Service Co 35 Mill Street C ntral Marlboro MA 01751 INSURER E; COVERAGES THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTUATwSTANDING ANY REQUIREMENT.TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S(JRJFCT TO All THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. Ron�UL LTRP9ucyuwiRATMN---- INSKE TYPE OF INSURANCE POLICY NUMBER DATE r TE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S1000000 A X COMMiRCLALGENERAL LIABILITY CPA0136157-11 02/01/06 02/01/07 PREMISES Esocmts mo) s250000 CLAIMS MADE a OCCUR MEDEXI'(AnYone Gerw) $5000 PERSONAL&ADV INJURY S1000000 GENERAL AGGREGATE s 2000000 GENIAGGRECATELIMITAPPLIES PER; PRODUCTS-COMPIOPAGO s2000000 POLICY PRO-- LOC - AUTOMOBR.!LIABILITY A ANY AUTO A0136158-11 02/01/06 02/01/07 COMBINeUsINGLELIMIr f 1000000 MA IEa eoelaeMl ALL OWNED AUTOS BODILY INJURYX SCHEDULED AUTOS f (Per peroon) X HIRED AUTOS BODILY wJUI:v f X NON-OWNED AUTOS (Pu accident) PROPERTY DAMAGE s (Per ecclden) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EAACC 8 AUTO ONLY: AGG f CXCFSSA)MBRELLA LIABILITY EACH OCCURRENCE s 3000000 AX OCCUR FICLAIMSMADE CUA0136160-11 02/01/06 02/01/07 AGGREGATE s3000000 f DEDUCTIBLE f X RETENTION so 'S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMIT$ ER A WCA0136159-11 02/01/06 02/01/07 E.L.EACHACCIDENT ^ 81000000 ANY FF ICEWMEMBER EXCLUDED?Fr,UTIVE _ E.L.DISEASE-EA EMPLOYEE 31000000 M yes,describe ulnae! SPECIAL PROVISIONS Delow E.L.DISEASE-POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAR.URE TO DO$0 SMALL SAMPLE FOR VENDORS IMPOSE NOOBuGATION OR LIABILITY OF ANY KIND UPON THE INSURCR,ITS AGENTS OR REFffAWATIVES, AUTH60JM n REPRESEN „',. ACORD 26(2001108) 0 ACORD CORPORATION 1888 I