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Home My WebLink AboutBuilding Permit #684 - 105 FARNUM STREET 4/24/2007 %40RTil BUILDING PERMIT c t�•o •1'�'0 TOWN OF NORTH ANDOVER 0r�° APPLICATION FOR PLAN EXAMINATION , Permit NO: 1• Date Received �9ss�cHus�t�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCAL I"Ott ' <tf1� U Print. PROPEY QWNt R-` AFP; Pri . r tU'A Na P/�t CEL. Z4P1!NG I�ISTI;t�C1" F l��t�i"t1 Dl�`�"F��C� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [Y-One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 'Aepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f v aterl�we, . ` _ F DESCRIPTION OF WORK TO BE PRIeFORMED: J Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: GO [YI` AC OI ami 4^ a Pho, n ^ f 4 ,a g ttOro's l'� CQl��tt�C�IC�t"f Lt�+�15�,:._,_ F ,�,..�:.v XK� x Hbrt�Irrrfir � eint Lic n a f a w 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. Total Project Cost: $^j� �o� • `-1° FEE: $ L �� Check No.: 40 4�f Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t guaranty fund Signature.of Agent/Owner Signature of contractor Location No. Date �ORTh TOWN OF NORTH ANDOVER f D i Certificate of Occupancy $ s'uMus t<' Building/Frame Permit Fee $ t Foundation Permit Fee $ �— Other Permit Fee $ TOTAL $ Check # 20 "1 � U Building Inspector 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS h 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 Located at 384 Osgood Street FIRE DEPARTMENT. `1i .E:umpster ort SItG', yes nig Lacatedat 124 Ma+n:Sfreet Fire t epit"rn siynatur ldat . z CI�4ItIEIfiS _ a �; ,.2 ns. "-``� ars:" m`'� "�.,�" ..- �'- s ,M�' 4 �;�f� r., -9�'r -8� ,a4�✓ � �' � ,�. �y �' 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.s100-s1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date ............................................................_..................................................._................__............_............................................................................................................................ . Doc.Building Permit Revised 2007 j 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ 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/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 ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 04/24/2007 13:24 6034324700 WHITTEMORE INSURANCE PAGE 02 OF ID 3 DATE(WMDYYI SC D,. CERTIFICATE OF LIARIUTY INSURANCE I_1 YYY Oa 24 07 PRODUCER THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Whittemore In�vranCe HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 501 MauSnoth Road ALTR THE COVERAAFFORDED BY THE POLICIES BELOW. Londonderry NH 03053 INS�EIE RAGE NAIL 0Phone: 603-432-2577 Fax:603-432-4700 ��• orsugco INSURGRA: Concord General Mutual INSURER 5: NCCi InC• - Nex Hampshire INSURER C: pCLBoxr6544 LLC INSURERD: Manchester NH 03108 INSURER E: COVERAGES THE POLICIES OF IIdBURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO ISSUED AN01NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICNT FXjIS CERTIFICATE MAY SE IONS OF S MAY PERTAIN,TME INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS,F�CCLUSION9 AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLARIS. UMTTS LTR ;A7A E OF URANCfi POLICY NUMBER DATE MMIDCfYY DA fi MRD EACH OCCURRENCE 31000000 ARILI Y x 500000 A RCIAL GENERAL LIABILITY E2 62 67 9-3 07/16/06 07/16/07 PREMISES lEot f AIM$MALE OCCUR MGD EXP(Any dro ool*en) 15000 PERSONAL t ADV INJURY t1000000 AENERALAGGREGATE s2000000 PRODUCT$•COMPIOP AGG L 2000000 EGATE LIMIT APPLIES PER: JECT LOC E LIABILITY COMBINED SINGLE LIMIT x (E+eeadenl) UTONEDAUTOBBQpILnURYULED AUTOS MIRED AUTO$ BODILY INJURY $ (Per PccIdenU NON•OWNED AUTOS PROPERTY DAMAGE S feel ettiden1l AUTO ONLY-EA ACCIDENT x OARAG@LIABLI Y EAACC $ LAAUTO ASI jT110 ONLYN 000 x EACH OCCURRENCE x d LALIABILITY CLAIMS MAGE AGGREGATE $sIk t t VVG WORKPRS COMPENSATION AND ?DRY LB+IITS ER B FMPLOYERS'LUK)IUTY "PLICATION STATUS 04/25/07 04/25/08 E.L.EACH ACCIDENT $100000 ANYPRRIMEMBERpS PART E E.L, ECUTIVE DIU-ME-CA EMPLOYE $100000 E.L.DISEASE-FOLK Y LIMIT $500000 SPECIAL�P O tS'1.0NS below HFR DESCRIPTION OF OPERATIONS I LOCATIONS I VfH14LE3I LUBIONBAODED B DOR9ER�NT/SPECIAL PRONSION9 Carpentry NOC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF E ABOVE DESCRIBED POLN:IEL BE CANCELLED BEFORE THE Exp IRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MNL 10 DAYS WRITTEN Town Of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DD SO SHALL Brian Leathe IMPOSE ND OBLIGATION OR LIABLI OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood St RGFRURNTATIVE'S North Andover MSL 01845 HoalzED A 0 ACORD CORPORATION 1988 LX-CORD 25(2001108) H.L. Martin, LLC Y ROOFING, WINDOWS, DOORS, SIDING I PO Box 6544, Manchester, NH 03108 H°M°S�9°73 (603) 623=8978 Fully Insured No CONTRACT Date,Zp d I(we),the undersigned;hereby accept your proposal to finish Labor and Material to perform the following work on premises located at the following address: No. /0 1 ,P ,vim S%. �', ex- 1714 a/ -es s- Owner's Name. J-064 Ile Ge,,v 'A.,0 6 ,T"' Tel Address In accordance with specifications given below: SPECIFICATIONS OF CONTRACT �- /�S C(2.e 2'141A-- Teed es s-r a,-.. u-/rod A e 4- s-c/ 4/1,r7 A r, '. .-C --- /ZI'0/0 /'o/54 r2 /_eiz For the sum of$ 7,0 f • f Additional work at Deposit$ 6'1 The undersigned property owner agrees upon completion of said work, to pay,cash (if any) $ 7' C,) /W- Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written. Buyer(s)Acknowledge Receiving a Completed Legible Copy of This Contract. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. L.S. By (Legal owner of property to be improve) �.,C%r� � (Authorized Agent)of 111.MARTIN,LLC (Husband or wife of legal resident) L.S. �J 1 a i OK Building Re Board of and Standar g ulations g ds �E- One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration r Registration: 154043 Type: Individual HERMEL L. MARTIN Expiration: 2/5/2009 Tr# 254097 HERMEL L MARTIN 850 WELLINGTON ST. MANCHESTER, NH 03104 Update Address and return card.Mark reason for change. ,-CA, �, 50M-05/06-PC8490 [� Address [-] Renewal [j Employment Lost Card .s*� ./�e "�G'o�irntoruuea�ffzo�iliCtldJucttuQet�6 Board of Building Regulations and Standards License or registration valid for indlvidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 154043 Board of Building Regulations and Standards Expiration; 2/5/2009 Tr# 254097 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.02108 iERMEL L.MARTIN iERMEL L MARTIN 150 WELLINGTON ST. MNCHESTER,NH 03104 Administrator Not valid without signature