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Home My WebLink AboutBuilding Permit #843 - 119 HICKORY HILL ROAD 6/20/2007 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,4y {{{ T ^ "A" Vry Date Received / 3 p0 4re Permit NO: 9SS�cHus�� Date Issued:"' IMPORTANT: Applicant must complete all items on this page 1.OTIVJ• .. 7. -�.. a Y� P �* � ,� x Y a a , PROP EIRE 41 s: t~II�fiORI ��" I �" + ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ,One family 11 Addition El Two or more family 0 Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 0 Demolition Ja OtherWOW Sw ..w � .y�{��■, (( ye{,�tr 71 AF ?" > .tr q_.F , 'a, t" e ''` .3" ✓v & "i "»^'zr.,,:v_ DESCRIPTION OF WORK TO BE PREFORMED: S 1 I+AT S a.J O A S(. 6ug>✓11� /Ze`i'7Jr.. r..I� G/rai t .dn.i7 A.� �N/�,2c.�s✓/� l 3S- l N� Identification Please Type or Print Clearly) OWNER: Name: M,&A,-%t t d SaVwr 1Ed u--r- Phone: 976` 60-976/ y/ Address:- 0 dd0asB. , Y ; 77 s VP StJ3CUIS `'S �It �tntlifi Ld+y1s rt z "Y'to @ irYri..�r !i•r fr k ! .,r „zr._ ;, Kc °+ H&m Crr► ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 O E T TAL ESTIMATED COST/BASED ON$125.00 PER S.F. � Total Project Cost: $ e O U )0 FEE: $ Check No.: ca Receipt No.: 01y 3' — NOTE: Persons contracting with unr istered contractors do not have access to the aranty fund Signature of Agin caner gnature of contract •� a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 1;. 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 LANNING & DEVELOPMENT ❑ ❑ COMMENTS I TE REJECTED DATE APPROVED CONSERVATI COMMENTS CU Q I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ Y COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Commen -(51.e, 1A Water& Sewer Con nection/S i-q nature &Date V Driveway Permit Located at 384 Osgood Street �?.f4 ✓vtA� �- FIREDEPART Temp Dupstec�n stte fires nc X Loafed at 424 Marg Firs Diprt stgnatuce{dt i e Dimension F 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 (fie TO Ls-1A a r l ❑ 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 u,-Building Permit Application , d Certified Surveyed Plot Plan /a' Workers Comp Affidavit ,al"'Photo Copy of H.I.C. And C.S.L. Licenses /❑ CApy Of Contract ,00r�-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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location ALS., f� No. Date V NORTH TOWN OF NORTH ANDOVER F 9 4 + ; ; Certificate of Occupancy $ �s-, CHUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2052 Building Inspector f Paul's Landscape Service, Inc. Estimate 634 Main Street Route # 38 Building# 3 Date Estimate# Wilmington, MA 01887-3234 5/9/2007 705009 Name/Address Janet Equi 119 Hickory Hill Road North Andover,MA 01845 P.O. No. Rep Account# FOB Project RPA Description Qty Rate Total Optional Items#2 28,500.00 28,500.00 Custom In Ground Pool(as per drawing). Thermo Plastic/acrylic Twelve foot Radius Step(white) ****Legacy Aluminum Coping Safety Fence 0.00 Temporary Construction Safety Fence Orange Secure Fence Steel Posts 72" Dig Safe 0.00 Notify Member Utilities PRIOR to Any Excavation Service(s). Contractor LIC#35239 Any questions pertaining to this estimate,please contact Bobby @ 781 933-2554.Thank You! Subtotal MA State Sales Tax (5.0%) Total Signature Phone# Fax# 781 933-7285 781 935-4099 Page 1 NORTH Town of No. o dover, Mass., 16 '•7a • ��' O Z LAK �. COCNIC NE WICK ORATED P .�y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System s � BUILDING INSPECTOR THIS CERTIFIES THAT........ 4' ........f� ......................... Foundation 1. has permission to erect........................................ buildings on .11i........ ..... .1 ..� i.�.l...... .-....................... Rough tobe occupied as....... irkl ........... .d. ................................................................................................... Chimney provided that the person a e tin this permit shall in eve respect conform to the terms of the application on file in P P P 9 P every P PP 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 S ELECTRICAL INSPECTOR + UNLESS CONSTRU ON T Rough .......... .................................. Service . .. .. ..... .............................................. BUILDING INSPECTOR Final i 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. Paul's Landscape Service, Inc. �sti m ate 634 Main Street Route# 38 Building# 3 Date Estimate# Wilmington, MA 01887-3234 5/9/2007 705009 Name/Address Janet Equi 119 Hickory Hill Road North Andover,MA 01845 i P.O. No. Rep Account# FOB Project RPA Description Qty Rate Total Optional Items#2 28,500.00 28,500.00 Custom In Ground Pool(as per drawing). Thermo Plastic/acrylic Twelve foot Radius Step(white) - Zo o ****Legacy Aluminum Coping t Safety Fence 0.00 Temporary Construction Safety Fence a ._ Orange Secure Fence Steel Posts 72" Dig Safe 0.00 . " Notify Member Utilities PRIOR to Any Excavation Service(s). ^` Contractor LIC#35239 Anp"uestions pertaining to this estimate,please contact Bobby @ 781 933-2554.Thank Xout;,; Subtotal MA State Sales Tax (5.0%) Total Signature Phone# Fax# 781 933-7285 781 935-4099 Pagel ✓tom -P� � °��°�� y R EGA LATIONS P BOARD�OF BUILDING . License: CONSTRUCTION SUPERVISOR Number: CS 071532 Birthdate: 1111011969 Tr.no: 8483.0 Expires: 1111012007 Restricted: 00, ROBERT P AUTENZIO ' 23 MILAN AVE N WOBURN, MA 01801 Commissioner 9/L ell U,qBoard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration; 1,30278 Expiration 2/_-J,/2008 r Type Private Corporation PAUL'S LANDSCAPE SEf2VICENC; ROBERT AUTENZIO ; r 23 MILAN AVE. NORTH WOBURN, MA OT801Deputy Administrator t MAY-07-2007 13:54 FRQM:IMPERIAL-POOLS AMES- 19783887415 T0:781 935 4099 P.2/2 FILE'07060461 8 8 8 2R 2R 611 X 12W STEEL 1 STAIR SF . 38'•9 • 30' 30'N&" 18' 18'•11'" . X. J 'J lT 40" DEEP SF 20' 1 ' 35 � 211 6 2RR SF■6Rx12W RECTANGLE STAIR FILLER 8 6 8' 1,•b" 17` R5'-q' 9R 6 6' 3'1 12" . 3'-6" R6' 9R 8'3' 9R 6'6' R9' LIN FT:114'-10" 8'3' DEEP 3' 8R 8'3" 8R L41- 10' 18' 28' Rt UM • IMPERIAL POOLE The � Commonwealth of Massachusetts 02 Department of Industrial Accidents Office of Investigations 600 Washington Street Ur Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers u de sonti/C A licant Information actors/Electricians/Plumbers Please Print Le ibl Name(Business/Organization/Individual): 'Au"(_'S ��,v9Scr� t Tvc. Address: Y ,M City/State/Zip:w� NA A K7 -3 21Y phone#: 7.0/ 9?3 Are you an employer?Check the appropriate box: 1.m I am a employer with FOu2(y) 4. ❑ I am a general contractor and I Type of project(required): 2.❑ employees(full and/or part-nine).* have hired the sub-contractors 6• ❑New construction I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'com 8 ❑Demolition [No workers'comp. ' P.insurance. p insurance 1 5. ❑ We area corporation and its 9. ❑Building addition required.] officers have exercised their 10-❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemptibri per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. C. 152 10), eP ions insurance required.]t employees.y )'and we have no 12•❑Roof repairs [No workers' comp.insurance required.] 13. Other /o/ *Any applicant that checks box#I must also fill out the section blow showing their workers'co t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating 1Contactors that check this box must attached an additional sheet showing the name of the sub-contractorsm rto sm her submit a ew mg such. Ian+an employer that is providing workers'compensation insurance for my employees Below is,the poke and ncy ation. information. . y ! b site Insurance Company Name: Z C7 Policy#or Self-ins.Lic. #: (AJC 7G yz 7.-r Expiration Date: —Trovv Z yn 2 cvg Job Site Address: 9 72�nW Attach a copy of the workers'compensation policy declaration page(showingCity/State/Zip: Policy number p: Failure to secure coverage as required under Section 25A of MGL . 152canlead to the imposition of criminald expiration datea fine up to$1,500.00 and/or one-year imprisonment,as well as civil Of up to$250.00 a day against the violator. Be advised that a co penalties of a penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification.copy of this statement may be forwarded to the Office of Ido hereby certify and r he pains and penalties of perjury teat the information provided above ' Si na e " �true and correcg �'° Da e: J ISN t' //� •ZC�� Phone#: OfJlcial use only. Do not write in this area,to be completed by city or town ofJleial City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2 6.Other g. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing I nspector Contact Person: Phone#: 06/11/2007 11:40 7812291178 GULDE INSURANCE PAGE 02/03 ACORD. CERTIFICATE OF LIABILITY INSURANCE 06/1ATE MIO2007) 06/11 2007 PRODUCER (781) 272-1070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Guide xi�eurancla Agency, Inc. (2} ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 279 Cambridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 36 Burlington MA 01.803- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER&ZURICH INSURANCE PAUL'S LANDSCAPING SERVICES & SUPPLIES LTD. INSURER B:AMERICAN HOME ASSURANCE 23 MILAN AVE INSURER C:MARYLAND CASUALTY CO INSURER D; WOBURN NA 01801- INSURER C: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITFI RESPECT TO WHICH THIS CERTIFICATIr 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 R INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDONY DAT2 MMIDDM/ LIMITS A OENERALLIABILITY SCP 014434689 01/18/2007 01/18/2008 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PRE •S Cooccurrence $ CLAIMS MADE U OCCUR / / / / M50 EXP An oneperson) S 10.000 HX INCLUDES. X-C AND U PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 OEN'L AGGREGATE,LqIIM�IIT APPLIES PER; PRODUCTS•COMPIOP AGO S 2,000,000 POLICY JEC7 7 I.00 C AUTOMOBILE LIABILITY CA 0090556663-02 01/18/2007 01/18/2008 COMBINED SINGLE LIMIT ANY AUTO (Eeealdenl) $ 1,000,000 ALL OWNED AUTOS / / / / BODII•Y INJURY (PC-.r per-..On) S � SCHEDULfDAUTOS X HIREDAUT08 / / / / BODILY INJURY S X NDN-OWNED AUTOS (Per SeCldenl) PROPERTY DAMAGC (Per OCCIOenl) GARAGE LIABILITY AUTO ONLY.FA ACCIDENT A ANY AUTO / / / / OTHER THAN EA ACC 9 AUTOONLY; AGO $ EXCESSIUMBRELLd11ABILITY / / / / EACH OCCURRENCE S OCCUR 71 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION S S B WORKERS COMPENSATION AND OAC 176-42-75 01/21/2007 01/21/2008TNCSTATU. OTH- EMPLOYERS'LIABILITY DRY LIMITS I I ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $. 500,000 OFFICF.RIMFMSER F•XCLUDF,01 / / / / E.l.DISEASE-EA EMPLOYEE,S 500,000 If yCi,de°JCnbe Under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WORK TO BE PERFORMED IS NORMAL AND CUSTOMARY FOR LANDSCAPE CONTRACTORS. CERTIFICATE HOLDER CANCELLATION ( } ( ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT JANET & MICHAEL EQUI FAILURE TO DO 90 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THF. 119 HICKORY HILL INSURER ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REM92 NORTH ANDOVER MA 01845- ACORD 25(2001108) Z ACORD CORPORATION 1988 vj'".INS025(0100).05 ELECTRONIC LASER FORMS.INC.•(BODIST•D Pngn I of 2 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1 '= 30' DATE:4/1612007 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. o 50 Deer Meadow Road WETLANDS ►_ _ Z North Andover, Mass. 1 107,+- - J DRAIN i EASEMENT --_LOT w i PLAN#1#1,811 56.5- 7, AT THE N.E.R.D: �� w - w- c� cn I I k/s Q L #,g 86 35,. v Nt o v o: I CERT/FY THAT OFFSETS-SFfOWNARE FOR THE USE Nt O THE OFFSETS OF THE BUILDING INSPECTOR ONLY �Ep�tH 0f SHOWN COMPLY AND SUCH USE IS FOR THE �yo� WITH THE ZONING DETERMINATION OF ZONING L BY LAWS OF CONFORMITY OR NON-CONFORMITY NORTH ANDOVER WHEN CONSTRUCTED. - WHEN BUILTs. STERE 6L LAW®°�'