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HomeMy WebLinkAboutBuilding Permit #757 - 110 SUTTON STREET 6/5/2006 TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXANtIV:3TIUN Date Received: 6-s s � Permit v0: Date Issued:b- jG IMPORTANT: A licant must complete all items on this page LOCATION �(/� 1 1©I� P rint PROPERTY OWNER ELUYuvl ( —__-- Print � ti9,�P NU.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT ERes=dential D USE Non- Residential One family = New Building = Industrial Addition Two or more family Alteration No. of units: acement Assesso Bldg -/--Commercial '�CRepair, repl �` !; .c Demolition Others: Movin (relocation = Other Foundation only DESCRIPTION OF WORK TO BE PREFORMED _ n f Sl w4� tw1Ar11 ,S � � � u rM a1�1 fist b S11(� D ?►� �Il Identification Please Type or Print Clearly) Phone: OA'N, ER: 'dame: K Address: -4 CU,ITRIXCTOR Marne: U� ,1 ,address: ale , ICING 20Es�,DI ction License: d� � Exp. Date:: Super%isor's Constru __ Home Improvement License: 3 ®� Exp. Date: RCHITL-'CT. ENC- NEER \cmc: Phcne: Wdress: Reg. No FEE SCHEDULE: St WING PERMIT:Sl o.j)o FER sj,!)10.a0 OF THE TOT IL ESTI.6I.t TED COST BASED O` ��•!�0 PER S� Total Project Cost :$__�_���d�Q � xl U.OU=FEE: t,:i!w h44 YYPE OF SEWARGE DISPOSAL - TanningAlassage Body Art SNimmin" Pools Public SeNer _ Food Packaein; Sales Well Tobacco Sales_ -- _ - Permanent Dempster on Site Private(septic tank,etc. _ Electric Meter location to project 'MOTE: Persons contracting wt' nregistered contractors do not/rave access to the guerrunlp.J'und Signature of,Agent,Owner /L Signature of Contractor Plans Submitted 7 Plans Waived � C rtified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FOR.1,1 - I _ - DATE REJECTED_ DATE APPROVED - PLANNING & DEVELOPMENT Ji []Water Shed Special Permit F1 Site Plan Special Permit J Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE :APPROVED HEALTH _ r I CO),/1-MENTSt Luning Board of Appeals. ariance. Petition No: tuning Decision:receipt submitted es irirmu, 6,tard I)(xis1on: _r nmmcnts _",tscivit cn Dcci:rion: -- _ -----C,�nunents '�: tl,'r•,''i-, v:,;;;u- .,;rnc.hc,n_ •�rlatCrt,&Jatc _,np DUMpster ctt site es no L' ;--,'re Department i`natur_ date BUIlding Pcrrnit Approxcd and 15SLIcd by: t Building Setback (tI.) Front Ward Side Yard Rear Yard Required Prop ided Required Provides —Required Provided 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 3 I i ,.c 1•I I_Cf.l."..'.I_',CI:�lC!:5 %I:I.'(I'.I�. LPD�:I•.:'�i�,� 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 j Building Permit Application ❑ Workers Comp Attida�it Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Buildng-Permit-A-pplication- ----------- ------- 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 Hydraui Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) 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 d of In all cases if a variance or special permit was required the Town Clerks threrded t the Regi ty office is Deeds. One cogrand .kppenis that the appeal period is over. The applicant must then g proof of recording must be submitted with the building application JONAL til{RNA t•:'-j I)EP tR]MF.%'':81'F01V11 S 4 LocationTy �U77�11 No. � Date NOR7y TOWN OF NORTH ANDOVER 3?O' .•o ,•1.x.0 ;4 0 w 9 • Certificate of Occupancy $ S�cMU S<� Building/Frame Permit Fee $ L�0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �_ V Building Inspector ' t BOARD OF BUILDING REGULATIONS } License: CONSTRUCTION SUPERVISOR E Number: CS 079129 Birthdate:-'-1010111957 Expires: 10/01/2006 Tr.no: 4044.0 Restricted: 00 DOUGLAS E MUND- 132 UND=132 KING ST GROVELAND, MA 01834 Commissioner ✓rte -� � ���� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Expiration: 8//24/2024/2007 Registration: One Ashburton Place Rm 1301 Boston,Ma 02108 Type: DBA DOUGLAS MUND DESIGN,GROUP. DOUGLAS MUND 132 KING ST. _„ , ref GROVELAND, MA 01834 Administrator Not valid without signature 'R f i AR WCIP Liberty ISSUING OFFICE 354 Mutual. Workers Compensation and INFORMATION PAGE Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group/Boston I 1-329840 0000 LIBERTY MUTUAL FIRE INSURANCE CO. 16586 POLICY NO. TD/CD SALES OFFICE CODE SALES CODE N/R 1ST WC2-31S-329840-035 XX X WESTON 102 REPRESENTATIVE 3000 2 YEAR ASSIGNED 2001 Item 1.Name of DOUGLAS MUND Insured DBA DOUGLAS MUND DESIGN GROUP FEIN 05-2843902 Address 132 KING ST RISK ID 196338 GROVELAND,MA 01834 Status 01 INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo.Day Year Mo.Day Year Item 2. Policy Period:From 08-14-05 to 08-14-06 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A.The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rates LINE 110 Estimated Per$100 Estimated Code Total Annual of RE- Annual Classifications No. Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 ( MA ) Total Estimated Annual Premium $ 1,574 Interim adjustment of premium shall be made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by SEE ATTACHED FORM 1710 Authorized Representative Date 08-17-05 Loc.Code Term. Oper. Audit Basis Periodic Payment Rating Basis Poi.H.G. Home State Dividend RENEWAL OF: 08-17-05 NR MA WC2-31S-329840-034 GPO 4030 Rl Copyright 1987 National Council on Compensation Insurance WC 00 00 01 A INSURED COPY One Beacon �Y - r [ y S U R .4 N C E COMMON POLICY DECLARATIONS ; r Company: EMPLOYERS FIRE INSURANCE Office: MASSACHUSETTS ' Transaction Type Issue Date Effective Date Rex Numberl Policy Number File Number P RENEWAL 08/25/2005 10/01/2005 1J5G4N I FB 1000755 12866018 3 NAMED INSURED and MAILING ADDRESS: AGENCY NAME AND ADDRESS: MR DOUGLAS E MUND 2079369 132 KING ST THE CITY INSURANCE AGENCY INC GROVELAND, MA 01834-1803 P.O. BOX 1297 HAVERHILL, MA 01830 D/B/A MUND DESIGN GROUP Business: Carpentry - Interior Form Of Ownership: Individual Policy Period: From: 10/01/2005 to 10/01/2006 at 12:01 AM Standard Time at the mailing address stated above. SPECIAL INFORMATION In return for the payment of all premiums, taxes, surcharges, recoupments and fees, and subject to all of the terms of this policy, we agree with you to provide the insurance stated in this policy. Description Premiums Commercial Property Coverage Part $0 Commercial General Liability Coverage Part $1,697 Commercial Inland Marine Coverage Part $156 Certified Acts of Terrorism Coverage $56 TOTAL PREMIUM: $1,909 Total Amount Due: $1,909.00 The Total Amount Due will be direct Installmatic billed. LOCATION INFORMATION Prem. Bldg. No. No. Address Occupancy 001 001 132 KING ST, GROVELAND, MA 01834 Contractor Your complete policy consists of Declarations, Forms and Endorsements made a part of this policy. As of the effective date shown, this policy consists of this Declarations and all other Declarations, Forms and Endorsements listed in the Policy Forms Schedule. POLICY FORMS SCHEDULE Form No. Title The forms marked with * reflect revised or new forms included with this coverage summary. C60001 1001 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CGO062 1202 WAR LIABILITY EXCLUSION C60431 0998 YEAR 2000 COMPUTER RELATED & OTHER ELECTRONIC PROB *CG2134 0187 EXCLUSION-DESIGNATED WORK C62147 0798 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG2151 0989 AMEND OF LIQ LIAB EXCL-EXCEPT FOR SCHLD ACTIVITIES C62167 0402 FUNGI OR BACTERIA EXCLUSION *CG2172 1202 NUCLEAR,BIOLOGICAL OR CHEMICAL TERRORISM EXCLUSI Authorized Representative: It e: zz7/113/ G15253 0602 INSURED COPY age 1 of 2 TAORTH , 0VM. of Andover - 0 . ..... ..... No. 64re Wrl 1 ........... * C10 f:' A O dover, Mass., COCMICMEWICK �� ✓�AORATED PPS\ BOARD OF HEALTH Food/Kitchen IJERMIT T D Septic System 4-4. BUILDING INSPECTOR THIS CERTIFIES THAT....................Rd ................�a.. ... . ... ...'. ..... ......................................... r" � Foundation has permission to erect........................................ buildings on .........�/v............ 1�. .... ....I....� � .. ........ Rough to be occupied as.........4i.. .. .r.......... �.. .� .......... � •.-1............y�..f....f..,�� Chn y m e provided that the person accepting this permit shall in every respect cont m 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 PERMIT EXPIRES IN 6 MONTHS Final O y 7 T �p 7 OT ELECTRICAL INSPECTOR UNLESS V DESS CONS 1 RlJCTIO S Rough ....... ..... .. .................. Service UILDING OR Final Occupancy Permit Required t® 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.