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HomeMy WebLinkAboutBuilding Permit #348 - 13 WALKER ROAD 10/29/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: r v IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER D)9 Print 100 Year Old'Structure yesno MAP NO: PARCEL. ZONING DISTRICT: Historic District yes no VN` Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A-One family ❑Addition ❑Two or more family ❑ Industrial C<Iteration No. of units: ❑ Commercial [Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:2 g 1, Phone: Address: c-4- CONTRACTOR CONTRACTOR Name: Z)- ,j. PPhone: ,3l / I Address: Supervisor's Construction License: C'S vim.3 J,// Exp. Date: 1 2Z,2 !� 3 Home Improvement License: /� 2. 7 38 Exp. Date: e/y/ V ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $_4( ?p �– Check No.: Pg�— Receipt No.: NOTE: Persons contracting nre eyed cont actors do not have a6ec ss to the guaran and ,Signature of Agent/Owner Signat` LL_ » contractor 49 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towp. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main Street Fire Department-signature/date COMMENTS I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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.$10041000 fine NOTES and DATA— (For department use El Notified for pickup - Date I E Doe.Building Permit Revised 2010 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) 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) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract o Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2012 Location ( � Kd, * No. l Date + • TOWN OF NORTH ANDOVER f � _ Certificate of Occupancy $ 41 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check#D 25883 Building Inspector NORTH own o _ t _E : ,, Andover h ver, Mass, ID COC LAKI NIC.1 WICK �•9 A°'AYIE ),.r s BOARD OF HEALTH PERM .IT T LD Food/Kitchen Septic System THIS CERTIFIES THAT �Doo*A........Lo BUILDING INSPECTOR Foundation has permission to erect . ........................ buildings on ... ... ......... • Rough tobe occupied as .... ` ... . .... .............�.�.. .....:................................. chimney provided that the person'accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough Service ..................... ... . ..... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE I-TI-f•1 : '='!=HHI-FIIEF' IIT=,1_11-HIil.E PHC1111= 1111. I,'[11,_1G' =;;'- Hpt-. �U 'U 1=�'�: 1^HII F'1 ' C )' � CERTIFICATE OF LIABILITY INSURANCE DhTE(MtdfDD1YYY/) 04/19/12 THIS CERTIFICATE IS ISSUED AS A MAI TFR OF INFORMAIION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMAI IVFLY OR NFGATIVLLY AMEND,f_XTFND OR At-TER THr(:OVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU FL A CONT RAC T BETWEEN THE ISSUING;INSURER(S),AUTHORIZED REPRESUNTA-TIVE OR PRODUCFR,ANU 1111_C'EIt11FICA"TE HOLDER. IMPORTANT; If tho cortifie:ate holder I9:tn ADDITIONAL INSURED,the policy(ios)must be endorsed. If SUBROGATION IS WAIVED,subject to the tertng arld conditions of the poliicy,certain police-may require art ondorsentent. A statement on this certlfiralte does not confor right,to the cortificate holder in liett of^,1IC11 ialtlor+,orlront(s). PRODUCER NAME: NT _.-._ -- --- AME: Schaffner hlsuiance Agency ( NFo EXD (978)851-2727 (ti.No): (978)64.0-9375 1147 Main 5t ADDRESS mbed.a.sctlaffn(-rL?vedzrn nct TowkSbrny.MA 01876 _ .-- INSURERS)AFFORDtNC COVERAGE -- ---.- NAIC 0 Phone (978)851_22727 Fax (978)640-9375 INSURER A: HERMITAGE INS CO INSURED INSURER 13: COMMERCE INS CO U&J CONSTRUCTION INSURERC: LIBERIY MUTUAL — 9 Mckenzie Circle INSURER D__ Tewksbury, Ma 01876- 978 INSURER E; _ INSURER F: COVERAGES CERTIFICATE NUMBER:_ REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLV7` PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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.LIMIT'S SHOWN MAY HAVE LEEN REDUCED BY PAID CLAIMS. INSR ADDLaUSR; TYPE( POLICY EFF POLICY EXP LTR___ __—_ �i'INSURANCE {NSR IM✓D POLICY NUMBER ;(MM/DOlYYYY) (MCPJDDIYYYY), LIMITS GENERAL LIABILITY EACH OCCURAENCE __L; 1,000,000.00 UAMAC E TO RENTED -V COMMFRCIAL GENERAL LIABILITY � _PRF-MoS(En cczurren,,6) :,_100.000.00 CLAltvIS•MADE OCCUP: FIGI.545547 MEL'EXI'{AnvOfrB.><:�nj $ 5,000.00 A - - 1 I/;)0/2-011 1 v30/2012 -- -- . . . — PLRSONAL u ADV INJURY a 1,000,000.00 --'-------_._ ,ENERALAGGREGATE s 1,000,000.00 GFNLAGGREGATELIMITAPPLIE,PFR PRODUCTS-COMPIOPAGG $ 1,000,000.00 POLICY PRO- LOG $ ' AUTOh10©ILE LIABILITY CON1,6INED SINGLE LIMIT — _ ANY AUTO BODILY INJURY(Par parson) ' S 500,000.00 AI.L OWNE=D SCHEDULED P95558 BODILY INJURY(Per �adrntl 'y 500.000.00 B AUTOS AUTOS 1011712.011 10/17/201 NUN-OWNEI) PROPERTY D"4A,t •------ . HIRED AUTOS AUTOS {Par acci-i nI) _ 100.000.00 _ 5 UMBRELLA LIAB -_1 OCCUR EACH OCCURRENCE u EXCESS LiAB -- CLAIM:.MADE AC'_REC•AFE DED /-- R_tTENTION5 WORKERS COMPENSATION - V✓C STA rU• OTH- ANO EMPLOYERS'L61BILIT-Y YIN --• •CORY LIMITS_]-:tv_�... ANYPROPRICTOR/PARTNENLXCCUTWE WC1-31S 326174 EL EACIIACCIDENT S 100,000.00 C OFFICERIMEMBER EXCLUDEO' N/A 0212112012 02/21/2013 --- (Mandatory In Nlfl El DISEASE-EA FMPI OYEk 1 100,000.00 it yeas,dascribe under ..._. DESCRIPTION OF OPERATIONS beio. E I_DISEASE-POLIcY LIMITS 500,000.00 i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,ArldItlonat RomarkIa 5chodul),H more apace is r"uimd) GENERAL LIABILITY INSURANCE FOR CARPENTRY AND R0 OPInlr__cTPFF CLEANING SNOW REMOVAL WORKERS COMPENSATION; INSURES CARPENTRY I t I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION;. I I AUTHORIZED REPRESENTATNE 1988-2010A- RDCO ORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD 1),,lyj 4-arl(i IOgo aro rogistered marks of ACORD Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-023711 `l��F.r`rs DANIEL N INdRSQ 9 McXENZIVtITt TEWKSBUR;C 01876 r °�..� Expiration Commissioner 12/17/2013 jm Office Y on` ume" airPs� unesVonLicense or registration valid for individul use only - -- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re istration: X107538 Type: Office of Consumer Affairs and Business Regulation Expiration: 814/2014 DBA 10 Park Plaza-Suite 5170 € Boston,MA 02116 D ONSTRUCT16k,_. Daniel Ingersoll 9 McKenzie Circles Tewksbury,MA 01876:;.,`-` Undersecretary a-� t Y Not val' wiE ut signature