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HomeMy WebLinkAboutBuilding Permit #50 - 121 HERRICK ROAD 7/19/2007 BUILDING PERMITF "°pT" q 20 10 ti TOWN OF NORTH ANDOVER a 4`�'" '-A. 6 0 APPLICATION FOR PLAN EXAMINATION r 0 Z , Permit NO: J Date Received '` 3 ^rAD 0, `y Date Issued: _,/ "' ACHUS 4 IMPORTANT:Applicant must complete all items on this page LOCATION_ -. .f PROPERTY OWNER NER I P ntr 'MAP NO: PARCEL BONING DtSTIICT �irstor.c Drstnct yes Sao �lachine:S,.opliiAage yep. no TYPE OF IMPROVEMENT OVE MEN T PROPOSED O OS ED USE Res i I Non- Residential New Building One family Addition Two or-more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other peptic _Well: Fbodp a ra lluetlands'' WaterWatei i7bed Distract W�ter/Sewet' DESCRIPTIONOF WORK TO 75foE PREFORMED: A Identification Pie se Type or Print Clearly) OWNER: Name:—LA 1 Yl D I-Q1 Phone: Address: CONTRA Narn�e ' CTOR t V. A ��� one "7 Address: J�4 Supervrs~or's Construction l.rcense� `Exp. Date _ 7 _ Home"lmpT. verr�e;nt J cense . Epp, Date: ARCHITECT/ENGINEER 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. I � Tota . I Project Co t. $ =�—�—�� 4j � a� FEE. $ --- OIW 39 Check No.: A 0 n 7i(3/Aeceipt No.: Odd NOTE: Persons e6niractin, 'h unregistered contractors do not have ac ess to the guaranty fund ig"wit—�f AgentlOmerU �g __e o cot ntractor �� _. 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 D REJECTED DATE APPROVED CONSERVATI (� COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS 4 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Con necti on/Sig nature &Date Drivewav Permit Located at 384 Osgood Street FIRE DEP ►R IWIEMT -Temp Duinpster on site yes no Located-at 124' 1 ginstreet ;Fire DeDartrnant,s'gnatureldate. 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 2007 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 A ❑ Building Permit Application a Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ,54-vi nom, o Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) r o 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) i E3 Building Permit Application k o Certified Proposed Plot Plan _ o 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products I 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 tl must be submitted with the building application Dor.INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location /of �e4ILILIZ �2fr No. Jy Date ALL= NORTH TOWN OF NORTH ANDOVER F � 9 Certificate of Occupancy $ s'•�c�°us•t4�' Building/Frame Permit Fee $ sH Foundation Permit Fee $ Other Permit Fee $ F TOTAL $ Check # 204 -E7 Building Inspector �.10RTIy Town of _ Andover No. SO �y o dower, Mass. T �- LAK ' ' COC MIC MEWICK V DRATED p' � `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ...... .. .!1. ............. .. . Foundation has permission to erect........................................ buildings on .... .. ........... ... . 06 Rough to be occupied as �► .1 ............................................................ Chimney ' provided that the person accepting this p rmd shall in every re ect conform 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough .. NAM 10 go I.S..................................................... Service BUILDING INSPECTOR 11 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. S E E REVERSE SIDE Smoke Det. SAHARA -1- The lightw aluminum is strong and durable,�111'11. 77 Sahara is the right choice for exceptional value! xs fr r 52 INCH t �W cQ WA,?, JohnnyWeis:muller Pools Features Available Sizes Liner -All-Weather J-Hook Metal 15' Round Deck Options Diamond Print Liner 18' Round Wall - Desert Flower Corrugated Aluminum 21' Round ,; Two-piece Top Seats - 8" Contoured Extruded Aluminum 24' Round Verticals - 7" Boxed Extruded Aluminum 27' Round Fantail Deck Tracks_-1 " Aluminum Top-& Bottom Rails 30' Round - End Deck Seat Cover - 2-Piece Extruded Aluminum 24' x 15' Oval Seat Cover 30' 15' Oval s ±= ' � � ." Combination (on select sizes only) Plates - Aluminum Top & Bottom Plates 33' x 18' Oval "CO NamcoPool.com 06,000 7 of NoeTp TOWN OF NORTH ANDOVER �o 3: .•,, ;. o� OFFICE OF F BUILDING DEPARTMENT W� * �e ;: 1600 Osgood Street Building 20, Suite 2-36 �'���ne✓e'.cy North Andover,Massachusetts 01845 �ss�c►agtt Gecald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION plem DATE: TT b JOB LOCATION: Number n Street Address Map W HOMEOWNER Lq 00 1'1"�� �1 ���-�0 8�(� �3�}`�' ��g- cI� �/• ��� Name Home Phone Work Phone PRESENT MAILING ADDRESS ��►�� �oa�. 0/Vs City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a ligase,provided that the ower acts as supervisor). State Building (Code*tion 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that helshe understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE d APPROVAL OF BUILDING OFFICIAL Rem 10.2005 Fomm HomwRa e s Exemption BOARD(V APPEALS 688-9541 CO SERvATION 688-9530 IIE.UJI1 6588-9540 PL:LV\[\G 688-9535 ACOR- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmrYY) 7/16/07 PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION . Davis, Clark & Latham Ins Agen ONLY AND CONFERS NO RIGHTS UPON T HECERTIFICATE One Pleasant St HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 505 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Preferred Mutual Viking General Contractors, In INSURER B: Attri: .Steve Secher 110 John Carver Road INSURER C: Reading, MA 01867 INSURER D: 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 D' POLICY EF FEC111nE FOUCY E1(PIRATION LTR R TYPEOFINSURANCE POLICY NUMBER DATE MM/DD DATE MWUDOV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY CPP0160510677 4/1/07 4/1/08 PREMISES EaoccuED- $ 100 000 CLAMS MADE OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $-1,000,000 POLICY jE O LOC I AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON-OWNED AUTOS (PeD1 ccildNent))RY $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ $ – RETENTION $ $ WORKERS COMPENSATION AND WCSTATU- 0TH EMPLOYERS'LIABILITY TORYUMITS ER ANY PROPRIETORIPARTNER/EXECUTINE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yas E.LDISEASE-EAEMPLOYEE $ SPECIAL be under IAL PROVISI ON S below E.L.DISEASE-POLICY LIMIT $ OTHER D ERCRIPTION OF OPERATIONS/LOCATONS/VEHICLES/EXCL USIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS POOL INSTALLATION WORKERS COMPENSATION CERTIFICATE WILL COME DIRECTLY FROM CARRIER AS AGENT DOES NOT HAVE AUTHORITY TO ISSUE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 10 DAYS W RITTEN Mrs. Allen 121 Herrick Road NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DOSO SHALL I MPOS ENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. E[ZED REPRESENTATIVE JO ACORD 25(2001/08) ©ACORD O TION 1988 J ZURICH WOFIKENCQMPENSJa 7107 AND EMP R$L ARl♦UTY POLIDI TYPE.Art INFORMA11ON PA60 WC 00 00 01 A POLICY NUMBER! (OZZUR-1401 COS---07) RENEWAL OF (GZ2W-1401 C58-4-06) INSURER, AWRICAN Z.IRICH 1WLRAWt COWANV t, MCCI CO CODE, "01,2 INSURED: PRODUCER: VIKING Gl<WM CONTF°ACT9ft INC DAVIS CLARK & LATW. INS 110 JOW CARVER ROM, W PLEASANT STREET* READING ISA 01817 Pad WX 505 READII t NA 01 W7 Incut+ed IS A CORPURAT ON Other wwk plaam Orr$ldarrtl catlon numbws am stam 1n the 1chadL440)attim1hed. p. The paaffcy period is fiom 03-21-07 io oa.v-oa 12,01 A.M.at the IrWred's melflnp addr 3. A. WORMERS COMPENSATION INSURANCE" Pert Om of the policy appilas to the Worim?k Compenafattan Law of ft ems(e)lletad here. NA 8, EMPLOYERS LIABI INSUR WE; PO Tarp of the p011cy appiles to wank In each doto ImW in bm 3.A, T e tlm"of our liability Under Part TWO:M,' Bodily lrqu ry by Accl0f t: .S 100000 Each AwAdent lolly lrqury by Q ; $ 'WmQ0 Pow Limit Bodily Iryury by Dimme: $ 100000 Each employee C, OTHER STATES INSURANCE: Part Three of the 00110Y 401104o the 91069. if.4nY;Ifartad harp: COVERAW REP"CID BY ENM'SEIjNT we 20 Oa 06A - i ©. Thls poky includes these endort*mWA rM schedUm. � SEE LISTING OF ENDURSEWNTS - EXTENSION OF IWO PAGE 4. The pmmiuim for thl$pallcy wlil be ds%rmkW by our Manualar of Rasa,0WOM10m.Ratan and Ratliv Iff flans. An mmyltlmd tntrmatIon Ie suojw t to verm orlon and chenp by audtt to tO madp ANNUALLY. DATE OF MUE: 03-21-07 . 0O ST ASSIGN; 44 OFFICE. "ICH-ORLAN 80.9 PRODUCER`. DAVIIA CLARK & LATHAM, YNS 22WT �eR7s