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Home My WebLink AboutBuilding Permit #682-11 - 11 GREENE STREET 4/8/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:* V // Date Received �' ��, // Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION -w TvL(�' I Print PROPERTY OWNER T �/Ik A Cr-X A Print MAP NO: 4 3 PARCEL: q 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ephc? ®WW e T o plain Wet Fl ® land � � Watershed District;s - DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) �,� 8 OWNER: Name: �.,. v Phone: 2 i 1 Address: �R- AWL CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $- 31//,�- FEE: $ Check No.: :� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature:ofcont'ractor. 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 er dumpster p permits require sign off from Ire F' Permit q g Department prior to Issuance of Bldg 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 ❑ 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 ❑ Engineering Affidavits for Engineered products d®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals tat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc-Building permit Revised 2008mi I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Mas sageBody Art ❑ Swimming Pools f P Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ �I 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 CONSERVATION Reviewed on / / Si nature COMMENTS A) Q_. *'—CL W i'n SOD' HEALTH Reviewed on Signature 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 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 i Dimension Number of Stories:________Total square feet of floor area, based on Exterior dimensions. areas Total land . ft.:q 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 i Doc:.Building Permit Revised 2008 Location/! eAee,l No. �''Z "�� Date /Ow NOR�p TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s►cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /33 24652 Building Inspector pRTly , 0 0 " _ 6 over . 0 - _ LAK -0 dover, Mass., Ild/I/ �/- COCWICHEWICK r 7� ORATED `S �J BOARD OF HEALTH Food/Kitchen. Septic System .PERMIT T D BUILDING INSPECTOR THISCERTIFIES THAT.......�..�.!!" .................. 1 VN,-. ........................................................................................... .................... Foundation �I�•'��Pil/l. 1 has permission to erect...............6........................ buildings on .— 'r ...... .. ................................................................ Rough to be occupied as....o�.`�......... �v✓4...... .�flr ..... � Chimney . .... ................................................................................... provided thatAhe person accepting this perm 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 r , - PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRUC N S 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1vivim it txaty i1r�rkuj'*IUI I MAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR:TIMOTHY * CELESTE VAUGHAN DEED REF: .95/G5 LOCATION: I I GREENE STREET PLAN REF: 285428 CITY,5TATE: N. ANDOVER SCALE: 1 "=30' DATE: 8/13/10 JOB #: 210.02574 nj SHED ® f i I jl k Po f I DECK I I/2 5T05.. STORY WOOD%BRICK GAR/ #II . f i LOT 4 I 162.02' GREENE STREET CERTIFIED TO: . i Flood hazard zone has been determined by scale i and is not necessarily accurate.Until definitive plans { are issued by HUD and/or a vertical control survey is performed precise elevations cannot be determined. NOTA: This mortgage Inspection was prepared This mortgage inspection was prepared in accordance specifically jbr mortgage purpose only and with the Technical Standards jbr Mortgage Loan is not to be relied upon as a land or property A Inspections as adopted by the Massachusetts Board of Jim sunxry, used recording, preparing deed Registration o Profissional ineem and Lanni[ descriptions, or co�shvction. o c-ornenerwens JOHN S nwyors 250 CMA 805. set. Building location and offsets are I further state that in my proossional opinion that eppmz{mately Located on ground and J. the structures shown ,onjbrrn with the local zoning horizontal are shown specifically jbr zoning determination RUSSELL d{mnio snal setback requirements u{rvments of the time of construction or only and are not to be used to establish property U #3 1 aro exempt under.previsions of M.G.L CH.. I0-A Sec: 7. tines. The matters shown hereon ars based on ,tient-f"rnished injbrmation and may be subject f. Property/House is not in blood Hazard to further out-sales, takings, easements and rightsM 2. Property/House is in a /Rood Hazard Area. of way, and other matters of record and preserpt{we J..gib°A'[ yC� O 3. Injbrmation is dnsufficent to determine Flood Hazard or other rights. Northern Associates. Inc. assumes no responsibility herein to land owner or occupant, l� Flood Hazard determined from, latest Federal Flood accepts no responsibility jbr damages resulting reliant by anyone-other than the said mortgagee atul its asst gnk' 1,manrnce Rate Map Acrel 075-flOJL in connection with its proposed mortgage finarneing to said mortgagor .Date 66-09-12M Za,e a BA RECEIPT NO. SERIES G M o Y 120 Route 101A ril ®''® Amherst, NH 0303150564 / r I �� :W ,�®►® ,'�► (603) 880-8471 Invoice No. L l fax: (603) 595-8497 ?i CIALTY STORES° email: store@seasonalstores.com Sls Ord Recorded �• _ _ S Date -, 1 ustom` r"' 1 r i 1 i L' L. `� �' t� 1 1' i "� Home Phone �• Address t 1 Ilk N, ; Cell Phone ��—•"f City l�ki State -Zip Ad Lead t 1C"' 1— SpecialOrder Ordered Received Called Taken Computer Due Completed ❑Custom Order proofed t I - SPECIAL INSTRUCTIONS: Sold By: -. - ; TOTAL ❑Cash ❑MC ❑Visa 96isc ❑GE D bit Deposit 1 ❑Ck# Initi Da In BALANCEI Customer Requests Delivery via:❑Pick Up ❑MrC ❑JDS ❑ ocash OMC ❑Visa DDisc DGE ❑Debit Deposit Product will not be used in a state that charges sales or use tax. Otherwise, customer may OCk# Initial BALANCE z be required to report such to that state. Date Inv# Initials: ❑Cash DMC ❑Visa ❑Disc ❑GE ❑Debit Deposita BEFORE PICKING UP YOUR MERCHANDISE please call the store 24 hours in advance, ❑Ck# Initial so we can have your purchase ready to take with you. DELIVERY of merchandise shall be Date Inv# BALANCE 3 solely in the mode selected by customer, which delivery shall be at customer's exclusive cost 03/28/2011 14:25 FAX IA003 MA R/28/2cl )A140 Q0•n f AM, .ti Fowler Insurance w: X No, `-978-"4-2206 o• i1-97 -"4-2206 P. 00(; n zI00 CERTIFICATE OF LIABILITY INSURAIICE DATE(M^/DDYTYY) 3/28/71 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. TMS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRE$ENTATiVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADOMONAL INSURED,the policy(ies) must be endorsed. ff$UBROGATION 15 WAIVED,subject to the teens and conditions ofthe policy,Certain policies may require an endorsement. A statement on this certificate does not Confer eights to the certificate holder in lieu ofsuch endorsement(s). PRODUCMCONTACT AMts: A & K Fowler Ins=anoe LLC PHONE � i �fXc No(: 200 Park Street Ross North Reading, MA 01854 PROD c x 1821 INSURENS)AFFORDING COVERAGE. NA109 MURED INSURER A:Preferred Matin Ll Insurance Com Fools by Us Plus IN$1,1RER e;Merchants Insurance Compsnv P.O. Pox 550 INSURER C:Li-bart-yMutualT ce Com an Wakefield, MA 01880 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LJSTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'WITH RESPECT TO WHICH THIS CERYFICA.TE 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 REDUCM 13Y PAID CLAIMS INSR1 AWL UBRI P l2 E LTR: TYPE OFiNSURANClE POUCYNUMBER lUB7 ! MMfDafYYYY I LlN9T3 GENFRALLIABILITY i i EaCHOCCURRENCE S 1,000,000 J. DAMAGE TO REN D 100 000 A j X ClcMERCIALGENERALLLABILITY CPP0120541343 5/4/10 5/4/11 Pa ��,. j I CLAM-WIADE .00CUR NZOEXP(A ons arson,) S QQQ PERSONAL&ADVIWURY j S 1,000,000 kG GfiNERALAGGREGATE s 2,000,000 'LAGGREGATEL�IITAPPLI=S PER I PRODUOTS-COMP/OPAGG $ 2,000,000 «t i POLICY PRO+ n LOC I 1 S AUTOMOBILELIABRITY I CONBINED SINGLELUIT Ml6/e to s/e/11' 13 � YAU7D �Mt~A7015125 � / I BODILY INJUkY(Perpbr:on) $ 250,000 hLLOVdNEDAUT08 BODILY INJURY(Per=6dent) $ 500,000 X I X- FIEDULEDAUTOS 'ROPEWYDAKAGE HIRED AUTOS i iP9ra41ld�,t) {5 250,000 I NON•OWNEDAUTOS I S j ` $ UM9PJ='LLAL1149 OCCUR j l FACH OCCURRENCE S EXCESS LIA6 I AC•C <3q(E g DEDUCTI51 E I I t IS RETENTION I S c WOR)CERSCOMPEN$AT(ONj iWC231S377330010 5/4/10 5/4/11 L•dCSTATUM1 IOTH• AND EMPLOYERS'LIABILITY ; ANY PROPRIETtaR/PARTNER/EXFCU WE YIN E.�.EACHACGGENT S 100,000 �I�ICcFRtdEMEthOCLll7ED? N/Ai j E.L.Dis EocsE-FA PjP LoYee •s 1.00,000 Rdardatory in NH) ti yod d=7lbevnCCr I DEO(RIPTION OF OPE RATIONStb I i E.L.OISEAiE-PULItYL1Y11T S 500,000 i I I I. I i DESCRIPTION OF OPERATIONS/L=MONS/VEWCLE5 (AttaGn ACORD 101,AtldBonal Rermrks Schedule,if more space Is mgUr*d) Insurance veri.ficatian CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLEID BEFORE THE EXPIRA-:'ION DA712. THEREOF, NOTICE WILL BE br:UVERED (N Tim & Celeste Vaucjhn ACCORDANCE WITH THE POL)CY PROVISIONS. 11 Greene fit. N. Andover, Ma 01845 AUTHORED REPRESENTATIVE I Kerri A. Boutin., CTC CRM C=SR ca 1988-2009 ACORD CORPORATION. All rights reserved_ ACORD 25(2009109) The AC ORD name and logo are registered marks of ACORD 03/28/2011 14:25 FAX QU004 | ! ' i | :\�<! . ! oil" and �� C�nmtru��ion �u�emisor Liwense | ucex�c� �S 42485 | 00 | ! ALBERTVV 8AN|uSuuuSu pOBOX 35U i VVAKEF\ELO, 01880 � ! 3�1�o2 ! ' . � 18329 ! � . |/ � � | | i �-~ Board o[nximinqDuco|^noovxnoSmxoo,u/ | HOME IMPROVEMENT CONTRACTOR ! Registration: 183112 | Expiration: 5/1112011 Tr# 284049 ' Type: Private Corporation | � POOLS BYUS, INC. ALBERT SANToSUOOSO ! 2VGARDEN 8T ! WAKEFIELD, �omi,immm, ' . � � ! ! i � . | ' � ! � ! / i � | | | ! / / i | ! �� | � . ' __|__....................__________�__ __