HomeMy WebLinkAboutBuilding Permit #027-2011 - 112 Forest Street 7/1/2010 BUILDING PERMIT of
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION it
Permit NO: bit Date Received
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Date Issued:-- :2111,10 CWi'
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IMPORTANT:Applicant must complete all items on this page
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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
Septic Well Floodplain Wetlands.-- ; , Watershedbj
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DESCRIPTION OFWORK TO BE PREFORMED:
Install Replacment Windows A)
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Identification Please Type or Print Clearly)
OWNER: Name: North--iAndover Housing Authority
Phone:
Address:one Morkeski Meadows
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Design Parynership
ARCHITECT/ENG INEER Arc i tects,Inc Phone:978-372-9400
Address85 Brockton Ave.Haverhill,Ma. 01 830 Reg. No. "33
FEE SCHEDULE;BULDINGPERMIT.$IZOOPER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F.
Total Project Cost: 137, 574j.00
FEE: C
Check No.: 44170
Receipt No.: al-5067
NOTE: Persons contracting with unregistered contractors do not have access to fl1i e guar^pmy fund
Bi nature of A _4
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Location
No. (�2 �o�d�/ Date /O
�aRTM TOWN OF NORTH ANDOVER
3? ' O0
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i Certificate of Occupancy $
Building/Frame Permit Fee $ Z
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 6 y 7,12.
23Cbi
Building Inspector
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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
CONSERVATION Reviewed on Signature
COMMENTS
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 Dumpsfer onsite yes'
Located at-124 Mam Str-eet
Fire,Departrient�signature/da#e _ 3s
--
I
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
al Inspector ector Yes No p
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
i
i
❑ Notified for pickup - Date
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Doc.Building Permit Revised 2010
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
❑ 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
N 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 2008
ORT#q
Town of Andover
No.
04z
0 _0 dover, Mass., 7//r
LAK
0COCHICHEWICK
.44 RATED C5
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
/Verv-4. '006-Y BUILDING INSPECTOR
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THIS CERTIFIES THAT.......................................................... .... . ......................................
or Foundation
has permission to erect................. ....................... buildings on 1,5........... .. ............................................................. Rough
to be occupied as......................... , ................... ..........................
Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application an 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 N 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU=O TARTS 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.
Clie :17263 WALCO
ACORD- CERTIFICATE OF LIABILITY INSURANCEo
PRooucex 10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
T.P.Daley Insurance Agcy,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1381 Westfield St BOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O.BOX 1150
West Springfield,MA 01090
INSURERS AFFORDING COVERAGE MAIC#
INSINZ,ED INSURERA: Travelers
Wail Construction
50 New State Road INsuRm 8: Acadia Insurance Companies
Montgomery,MA 01085 INSURERC,
INSURER D:
COVERAGES INSURER E:
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR WN TYPE OF INSURANCE POLICY NUMBER I DATE allUDWM Lam
A GENERAL LIABILITY I6803011WT55COF09 12/04/09 1210410 EACH OCCURRENCE $1,000.000
X COMMERCIAL GENERAL UABLRY DAMAGE TO RENTEDNW.0
00
CLAIMS MADE F OCCUR MED EXP Arty one person) S5 0w
PERSONAL&ADV INJURY S7 000 000
GENERAL AGGREGATE s 000 000
GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-CDMP/OP AGG s2,000,000
POLICY MPRo LOC
A AUTOMOBILE LIABB TY AOSA5656P7791ND09 12122!09 12@2110 COMBINED SINGLE LIMIT
ANYAUTO Ma ,) s1,000,000
ALL OWNED AUTOS
X SCHEDULED AUTOS BODILY INJURY :
Per Person)
HIRED AUTOS
NON-OWNED AUTOS (Perso 1)d- Y s
rn�* n
MQTY DAMAGE $
rx}
GARAGELUI3UTY AUTO ONLY-EA ACCIDENT $
ANYAUTO
OTHER THAN EAACC $
ALTTOONLY: AGG $
EXCESSAJMBREIJA L&AxLnY - EACH OCCURRENCE $
OCCUR FICLALMS MADE AGGREGATE $
DEDUCTIBLE S
RETENTION
A woRaw eoMPEwATm AND XACRUS3175W37AO9 12!04/09 12/04/10 WC SiaTIY OTF+ i
ELTPLOYERS•LIABMYEMR
ANY PROPRIETUR/PARTNERIE)�CUTIVE E.L.EACH ACCIDENT $500 000
OFFICERPoIl-7,iBER EXCLUDED?
ITy� rtb
desee under EL DISEASE-M E mpLO $600.000
PECULL PROMS NS below
El.D*EAw-POLICY UMIT low,OOii
B OTS Installation APP60761 OS20/10 05120/11 $100,000
Floater $1,000 deductible
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VETiCLU I EXCLUSIONS ADO®BY ENDORSMWMT/SPECIAL PROVISIONS
Window Replacement at Morkeski Meadows,North Andover,MA.
CERTIFICATE H DER CANCELLATION
North Andover Housing Authority
SHOULD ANY OF THE ABOVE DESCIMM POLICIES BE CANCELLED BEFOGHE TWIPlRATON
DATE THEREOF,THE ISSUING MURE WILL ENDEAVOR To MAIL
One Morkeski Meadows -_30-- DaYswarrEM
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, RE BUT FAILUTO OO 80 SHALL.
North Andover,MA 01845 I oB11GATTON of ANY?OND
OR
ATNES.
REPRESI9tTA
ACORD Z5(2op1/pgI 1 of 2 #S77911/M77142
TMG 0 ACORD CORPORq
Board of Buildinga ulafio � andStandards
HOME IMPROVEMENT CONTRACTOR
MY
Registration: 11800
*, E pig` tl n.6 1/1312011Tr# 278871
Type: Partnership
-WALL CONSTRUCTION
JAMES WALE,
0 NEWSTATE RD
MONTGOMERY, MA 01085 AdmiWistrator
Boat
Construction Supervisor License
License'. CS 51575
ra
Restricted to. 00
JAMES D WALL I
50 EW TTE -RD
-
'MONTGOMERY', MA 01, 085
Expiration: 1/11712011
r�iii��i �_ � r• Tr#,, 8797
C _
T
The Common earth of Nlassachusetts
Department of Fire Services
Office of the State Fire Marshal .
P.0.Bos 1025 StiteRoad,.Stow,MA 01775 / )
PERMIT Date:
North Andover Permit No
(City of Town) (If Applicable) Dig Safe Number
Ea accordance withthe provisions of M:G.L.l 4 8 Chapter 10 as provided in section S 2 7 CyI`'I R 34 start Dace
This Permit is granted to:
Full name of person,Firm or Corporation
Pennissionto locate dumpster for construction/renovation/demolition of building.
Comments: dumpster must be . 25 ' from structure if unable to place with required
Restrictions: clearance dumpster must be covered with plywood or tarp end of work -dap
at 0't
(Give location by street and no.,or VErle in such marine o provi ad`qu e identification of location)
Fee Paid$ 50 .00 Fire Chief
This Permit will expire 3�- U (Signat :9 cal-granting permit) Offical granting pcmut (Title)