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HomeMy WebLinkAboutBuilding Permit #055 - 117 MAIN STREET 7/23/2008 BUILDING PERMIT Of NORtAORTFr TOWN OF NORTH ANDOVER o? APPLICATION FOR PLAN EXAMINATION Permit NO: Os 5 Date Received 2:Eups �s °ogwT•p pa`�g '7 �SgACHUSE� Date Issued: 1'2,-,--' � � r IMPORTANT:Applicant must complete all items on this page LOCATION 5;5OG-t Print WIT- Print �� PROPERTY OWNER (C> -OW � W IT Print MAP NO: Z PARCEL: A4E>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, re acement Assessory Bldg Others: emoliti Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: LADiJ 4 Atte";s6 , r1nr0- �5,4WAepE � DlsPoS C- Identification Please or Pint Cl�rly)�. OWNER: Name: �L� C�G"�� _ -[�(�b Phone: Address: CONTRACTOR Name: • 9 • f2o a Phone: T75 d � Address: t5j w Supervisor's Construction License: 0:?(43 E>536 Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/ENGINEE R_ Jr Phone: q7 7`t Address: Reg. No._ Z�, ' FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2�! ©©� FEE: $ Check No.: �� Receipt No.: 45g; NOTE: Persons contracting with unregistered contractors do not have access to =nd Signature of Agent/Owner Signature of contract Plans Submitted Plans Waived Certified Plot Plan Stamped Plans i 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 I 'I. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r 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 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.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 _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 ❑ 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 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 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Loc ation/ ��� <J S S Date 2 6Y No. , N°RTM TOWN OF NORTH ANDOVER . ; . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit.Fee $ Other Permit Fee $ TOTAL s,��74 SSG $ 7 G Check # 2 ' � U Bdfi n9 inspector ector NORTH To" of Andover No. p S� '_ _ Da V t__ . 71 0 over, Mass., 0 0 - LAKE C CHICHEWICK ��S RATED P? C3 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................... N.X.a.v....X!N*.17�� 7�6117w................................................................... .. ...... ... .. ... ..... .... ...... Foundation has permission to erect......................................... buildings ......re- ................. ... Rough to be occupied as...... . ......... . Chimney rc ........... provided that the person accepting this permit shall in every respect conform to the terffis 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 CONSTRUCTIO STAR S Rough ..... .......... . Service BUIL B* G iNspic;f6k Final Occupancy Permit Required to Ocmpy 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. ACORD. CERTIFICATE OF LIABILITY INSURANCE DA D 07/14//14/2008008 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rose Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:CO10ny Insurance Rumpf Design Group INSURERS:Granite State 74 Wharf Street INSURER C: INSURER D: Salem MA 01970— INSURER E: COVERAGES 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MWDDNY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE X COMRENTED MERCIAL GENERAL LIABILITY -PREMISES Ea occurrenceS 50,000 CLAIMS MADE �OCCUR GL3546724 04/10/2008 04/10/2009 MED EXP(An one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 / / / / GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JE COT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / OTHER THAN EA ACC S AUTOONLY: AGG S EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND WC4393610 07/26/2007 07/26/2008 g I WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEES 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSJVEHICLESIEXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of North Andover FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 0p AUN THORIZE ETATE 'C�/`� r r. rt B /fr oft-m-09' eSu a ions a� Construction S. tand rrds UPervisor License License: C S 38856 1 /20/2009 Tr# 20683 z i P ERIC R RUMPF'k: Pb BOX 4483 t f SALEM,MA 01970 Commissioner t c