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Home My WebLink AboutBuilding Permit #372-2011 - 125 WINDKIST FARM ROAD 11/2/2010 BUILDING PERMIT o�No D b TOWN OF NORTH ANDOVER �2 5 ','- -:: , APPLICATION FOR PLAN EXAMINATION ~ / PermitYV Date Received �q °RA "�c5 SSACHUSE Date Issued: D� IMPORTiANT: Applicant must complete all items on this page LOCATION io23' Cy�iJO,��'S% y¢2J� PROPERTY OWNER - �tJ1N�. rrint i� ' � , 7xus Print MAP-210/01 PARCEL: ZONING_DISTRICT: Historic District. yes. Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other b Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District. ❑Water/Sewer r. DESCRIPTION OF WORK TO BE PERFORMED: Rte' Ag1m741�71 /5 A.1 IdentificatiZntWqV-A7pePlease Tyor Print Clearly) OWNER: Name: Zai G A Phone: Cg 78)6 l- fi g Address: ! � 6t/%v�IC 'f% �9�'► CONTRACTOR Name: Phone- -Address. F hone-Address. F .O_ od& . Z Z a�w rl 1 Supervisor's Construction License: �S i'��/� Exp. Date: - .lt - . j Home Improvement License: Exp. Date` ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT;$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON j $925.00 PER S.F. Total Project Cost: $ �;;b oov FEE: $ Check No.: 3 d Receipt No.: �� NOTE: Persons contracting it unregistered co actors do not have access to the guars_ ty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 Siqnature COMMENTS I 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 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 i i i i Notified for pickup - Date Doc.Building Permit Revised 2010/October 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 DOTE: 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 N OTE: 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 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 Doe:Building Permit Revised 2008 Locatiox5— ��i�� ^[— No. _ Date NORTH TOWN OF NORTH ANDOVER O F 9 Certificate of Occupancy $ Building/Frame Permit Fee $ R �� ncMus Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ Check 236 , 1 Building Inspector NRTH 0 0 , Andover 0 .1,11111.1-111", -aJA11- ,1,K; No. 7,2 _�__,. dover, IVMass., COC HIC HE WICK y�. ORATED � VV ` BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Cr........ `....................................................... tion has permission to erect... buildings on ...�.�. ..:..�. r. ....��.l�.. 4.t.. ............ Rough to be occupied as.......... .. Chimney ........................ . .......................................................... provided that the perso accept g this permit shall in every act conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws re ing 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 CONSTRUCTIRLOO== S Rough .............. .. Service BUILDING INSPECTOR 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: At /t/, (Location of Facility) Signature of Permit Applicant Date .............. ............................ . POLICY NUMBER: 2005W6783 SERVICED BY YOUR AGENT: 3590 MICHAEL A EMOND ISSUED TO: 857 TURNPIKE ST NORTH ANDOVER MA 01845-6140 WINDKIST EQUESTRIAN CENTRE INC 125 WINDKIST FARM RD N ANDOVER, MA 01845-6353 IN WITNESS WHEREOF, the Company has caused this policy to be signed by its President and Secretary, but if required by state law, this policy shall not be valid unless countersigned by a duly authorized representative of the Company. Secretary Pr dent X-3352(11/03) To Notify Us Promptly of a Loss, Please Cal/ 877-383-7019 Thank You. 857 TURNPIKE NORTH ANDOVER MA 01845-6140 FARM FAMILY CASUALTY INSURANCE COMPANY 978-208-4713 NCCI COMPANY NO. 16721 POLICY NO 2005WS783 €< INSURED AND MAILING ADDRESS: . RENEWAL OF NO. 2005W6783 .::::::::::::.:::...:.::::......................... WINDKIST EQUESTRIAN CENTRE INC EFFECTIVE 6/17/10 125 WINDKIST FARM RD N ANDOVER, MA 01845-6353 THE INSURED IS CORPORATION Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 01 125 WINDKIST FARM ROAD 187496 NORTH ANDOVER MA The policy period is from 8/17/10 to 6/17/11 12:01 A.M. Standard Time at the insured's mailing address. -.. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease $ 500,000 each accident $ 500,000 policy limit $ 500,000 each employee I C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3.A. of the information page and ND, OH, WA, and WY I D. This policy includes these endorsements and schedules: WC 00 00 OOA WC 00 00 01 WC 00 03 15 WC 00 04 14 WC 00 04 22A WC 20 03 01 WC 20 03 02A WC 20 03 03C WC 20 04 05 WC 20 06 01A Copyright 1987 National Council INSURED COPY pROCESSED 05/06/10 on Compensation Insurance, WC 00 00 01 Issuing Office - PO Box 656 • ALBANY, NEW YORK 12201-0656 i ~ M.Issachusetts- Department of Public Safet% Bo;u'd of Building Re( ndations and Standau•dS Construction Supervisor License License: CS', 10296 _ ERNEST A'LANGTHORNE PO BOX 922 # PLYMOUTH, MA 02362 c Jam- Expiration: 4/11/2012 -('ununissibncr---- — Tr#: 6016