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HomeMy WebLinkAboutBuilding Permit #744 - 133 MAIN STREET 6/30/2009 NORTH BUILDING PERMIT 0 'Ufo 16'�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: :4k Date Received 9SSACH�15�� Date Issued: —,;-Z)-vf IMPORTANT:Applicant must complete all items on this page 2 LOCATION YIQ PROPERTY OWNER t ( � � y Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration v No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer / DESCRIPTION OF ORK T E PR FORMED. 13 tvl 0 die ATO h UVI I't1 h,wr/cql—le—e, 01 Identification Please Type or Print Clearly) OWNER: Name: Yom- laoix 7 Phone: 7F/ 6Yo6ffl-� Address: ( e �t4 (2d r�-, CONTRACTOR Name: lad 6 Qati'a InPh one: Address: 0--7- I �Emt C7- Supervisor's Construction License: Exp. Date: Home Improvement License: /2d/ 99 Exp. Date: /1 'Ldf 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: $ p 7�'L FEE: $ -� Check No.: `1`.J Receipt No.:_0 NOTE: Persons contracting with unregistered contractors do not have a cess to the gu ty fund �ignature of Agent/Owner Signature of contractor 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 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ 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 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 2.2008 Location.Z 33 /. M2 •t/�_ No. Date d f NORTITOWN OF NORTH ANDOVER : 1.t.� • O 16. ' Certificate of Occupancy $ uE<� Building/Frame Permit Fee $ rte' •►cMs Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check # ,3 221 Gu Building Inspector NORTH Town of Andover No. I A- dower, M ev .la 0 -- 0 ass., 0 - L W COCHICHEWIT �. 04ATED Ok? C7 BOARD OF HEALTH Food/Kitchen PERMIT. T D Septic System BUILDING INSPECTOR 1A THIS CERTIFIES THAT...... ... ... ..4!*........................ ....... .................................................. . ........................... Foundation has permission to erect........... .. ......... . .......... buildings on ............IT).....W001 ... ...... .. ... ................... Rough to be occupied as.....1.3........?a . -mit .......&x)s n d�.......a...— '­'0aMMQMftftft. Chimney provided that the person accepting permit shall in every respect conform to the onfii'­ ­ einFinal 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 CONS N TS Rough ..... ......................................................................... .................. Service BUILDING IN 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. SEE REVERSE SIDE Smoke Det. •. rO-RDERTIFICATE OF LIABILITY INSURANCE DATE{MRi1DD1YYYY) 03/13/2009 a)d&Pangione Insurance Agency, Inc. ONLYCAN pFCONFERSSASIOERiGHs hUP�ONRTHE(CERT fACATE x 428 HOLDER. THIS CERTIFICATE NOT AMEND,n Street ALEXTEND OR TER THE CQVERAGE AFORDESYTHE POtCIES ELOWdover,MA 01845 ' 'INSURERS AFFORDING COVERAGEracting,Inc i MAIC# san€St. A Rrefeed_Mut{ral lnswanee Cvm any _ N Andover,NIA 01845 Imo"I�B Safe Indemnity insurance Company - " RE-c Insurance Go of thP State of Penmyt fnnia ttiS'tiR�D: COVERAGES INSUR 3i THE POLICIES OF INSURANCE LISTED BELOW"AVE gEE(� �TO THE!f 1SLJRED NAMED ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER WITH RE FOR THE-POUCY PERIOD INDICATED.NOTWITHSTAIJ(?ING MAY PERTAIN,THE INSURANCE AFFORDED A THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLl1StOMS AND CONDITIONS OF SUCH DOCUMENT 1Nrri t RESPECT TO't+YyICFI THIS CERTIFlCATE MAY SE ISSUED OR POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN R INSR IYL EDUCED BY PAID CLAIMS_ LTR N3 — _ --- _ A ` GENEM IJABBJTY I DATE ` DATEM -- LIdBfS - —------ jl COMMERCIAL GENERAL lMfM '°�' S 1000,000. CPPDG01 i To. D I f CLAIMS AIADE I(OCCUR 07/18/08 � 07118/09 k4ED EXP $ ---50 000 MED EXP(Arty one Person) S 5,000. . I _ PERSONAL 6 ADV INJURY g 1,0W OQ0. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S Z�d{100. PoucY JECTPRO- Loc P�Rooucrs-COMPAOPAGG $ 2000 000. I AU70MOBILEiJABIL(TV I - - f ANY AUTO l I 3116538 I COMBINED SIMGI,-LIWT ! �ALLOWNEDAUTOS 07/18!08 07/18/fl9 (Eaacciderrq IS 1,000,000. I X' ) JJJ SCHEDULED AUTOS f J BODILY INJURY i 1 HIREDAUTOS 1 (Per Pe—n) S X NON-OWNED AUTOS BODILY INJURY (Peraccident) S ' GARAGELIABIi.fty =)DAMAGE $ . ANY AUTO I IAUTO ONLY-F.AACCIDENT g I OTHER THAN EA ACC S £7(CESVUMBREFZA L&AH1UTV AUTOONLY: AGG $ OCCUR CLAM MADE EACH OCCURRENCE S. AGGREGATE $ DEDUCTIBLE' 1+ f 5 RETENTION S $ C WORKERS COMPENSATION AND EMPLOYERS'Lt SL" V%rW353147503/31109 fl3/31110 X- WC STATUI OTH- $ ANY PROPRtETORJPARTNERRXEfTpiE IM Ct � t OFFICERIMEMBER f7(CLUDEDa ii11 E-L.EACH ACCIDEM S 100000 W, nbe Under SPECIAL PROVISIONS below E.LFJMPLOYEE $ 100 000 OTHEREL DISEASE-POLtCYUM(T IS 500.000 DESCRIPTION OF OPERATIONS fLOCAnoMS!VUCCLES!EXCLU9pHSAODWiffawoR Tt certificate holder as listed below CERTIFICATE HOLDER CANCELLATION . - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 'DATE THEREOF,THE ESUNG INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN r+w _ ROME TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE 70 DO SO SHALL WPOSE NO OBLIGATION OR LMKrFy OF ANY MND UPON THE INSURER,ITS AGENTS OR REPRESENTATNES, a- s� '`" AUTHbRQEDREPRESFtlTAT1ME ACORD 25(2001108) ©ACORD CORPORATION 1988 r—. ,; Itdall At coot m s M rna � ext tom;h 4 DAVID P,QV