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HomeMy WebLinkAboutBuilding Permit #293 - 119 OLD FARM ROAD 10/13/2006 TOWN OF NORTH ANDOVER NORTki APPLICATION FOR PLAN EXAMINATION o*�SLLD ,6q~o o Permit NO: Date Received ^� a y�. Date Issued:A2 ��SSgcHus���y IMPORTANT: Applicant must complete all items on this page LOCATION 1 �dCiP^4.M 1C� Print PROPERTY OWNER 4,e r F Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building 11'6ne family ❑ Addition ❑Two or more family ❑ Industrial R"A"'Iteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identificpation Please Type or Print Clearly) OWNER: Name: Phone: Address: 11q d)k 0 -P, CONTRACTOR Name: J oSr.D tl .&4�kcA— Phone: aj �� f` e/6/3,y Address: 4 �.� S-r- Supervisor's Construction License: ('� d �'Z g 0 Exp. Date: he)/0 7 Home Improvement License: Exp. Date: /7-lZZ16 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ t$/6 'C900 , FEE:$ Check No.: S � Receipt No.: 646 Page I of 4 xwt I TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ 11Tanning/Massage/Body Art ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature nature of contractor 6 Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM i DATE REJECTED DATE APPROVED j PLANNING & DEVELOPMENT F1 ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r FIRE DEPARTMENT - Temp Dumpster on site yes o — —0-6 Fire Department signature/date 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 Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided 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 Page 3 of'4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 I Addition Or Decks t ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) I ❑ 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 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:BPFORM05 Page 4 of 4 The Commonwealth of Massachusetts j Department of Fire Services Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMIT Date: fv�1�o6 North Andover permit No (City of Town) (If Applicable) Dig Safe Num er In accordance with the provisions of M.G.L.1 4 8 Chapter_J_Q_as provided in section 5 2 7 G M R 34 Start Date This Permit is granted to: Full name of person,Firm or Corporation ; Permissionto locate dumpster for construction/renovation/demolition of building. Continents: 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 day at (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ 50.00 Fire Chief / This Permit will expire �/ ' d w,6 (signature of offical granting permit) Offical granting permit 7 (Title) /ze iGa�noianj�ufeaL TIONS BOARD OF BUILDING REGULATIONS CONSTRUCTION SUPERVISOR License: CS 065280 Number: Birthdate: 0912011963 15890 J ires' 0912012007 Tr.no: y Exp .�.- Restricted: 00 ,JOSEPH G BtpNCHET t, p0 BOX 241 03811 Commissioner 4 ATKINSON, NH 1 /= -4 Board of$uildi j� _ HOME i ng Regula tions a MPRpyEME nd Standards Registratlo►► NTCOIVIRACTOR EXplration; 145193. 121221200 JOSE r YPe: Indiv' 6 P ACHET i H gL dual JO SEPH 1. L4NC 124 LAKE SiyET. ! 4 A T, TK I NSON.MA 08311 - G�.►4 4d►hini01ator I , I ACOMCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/ 8/31/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Circle Business Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 247 Newbury St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Danvers, MA 01923 978-777-7030 INSURERS AFFORDING COVERAGE NAIC# INSURED Joseph Blanchet INSURER A: PENN-AMERICA INSURER B: 124 Lake Street INSURER C: Haverhill, MA 01832 INSURER D: 978-994-6134 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 DDLPOLICYEFFIE E POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 50 000 CLAIMSMADE CI OCCUR MED EXP(Any one person) $ 5 000 X TBD 9-1-06 9-1-07 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO- JECT F7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Peraccident) o PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND S1 JOTH EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE$ IfYes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OFI�ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN HALL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ANDOVER, MA 01810 IMPOSE NO OBLIGATION OR LIAB TY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT VE ACORD25(2001/08) ©ACORD CORPORATION 1988 V40RTH own of Andover No. Z �'3 _ `A dover, Mass., u. 110&6Ap C CHICHEWICK\11 1. Of'�ATED Cl BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.......1.(..i.......... BUILDING INSPECTOR ................. .......%W..... .................. Foundation has permission to erect........................................ buildings ...... .... . . . ........ 3% Rough ................... to be occupied as...f.0%cla....... .. ....'. A&*L& &.AJ ...GA.t.ft ft4o 60 Chimney provided that the person accepting this permit shall i every re*ect conform to t6 ffirms of thea pplication 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 PERMITEXPIRES IN 6 MONTHSFinal ELECTRIC AL INSPECTOR UNLESS CONSTRUI<ON Rough ................. ................. . . ...... ... magmas..... Service UILDING INSPECTOR Final Occupancy Permit Required to Ocuipy Building GAS INSPECTOR nal RDisplay in a Conspicuous 'Place on the Premises — Do Not Remove Fi No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Bui lding Inspector. Bumer Street No. SEE REVERSE SIDE j Smoke Det. k. Location k / f No. L Date lo NORTH TOWN OF NORTH ANDOVER O't.♦o :♦'�,y0 F - A t a A • i ; : Certificate of Occupancy $ ''+s •ESQ' Building/Frame Permit Fee $ s�CHus t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F Check # 19636 Building Inspector