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Home My WebLink AboutBuilding Permit #073-14 - 15 CABOT ROAD 7/22/2013 TOWN OF NORTH ANDOVER f APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ; Date Issued: IMPORTANT:Applicant must complete all items on this page y LOCATION ,l3dr � Pant . PROPERTY 01NNER Punt MAP NO PARC EL:'Z/b ZONINGk,DISTRICT: µµHistoric District $yes -no Machine-Shop Village ayes no TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building Ad 'tion Two or more family Industrial teration C No. of units: Commercial replacement Assessory Bldg Others: Demolition Other Setjc Well, Floodplain :Wetlands Watershed Dstnict Water/Sewer _ . DESCRIPTION OF WORK TO BE . r PERFORMED. Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name, YA- UJt1 '.,Phon- ey: Address: � � _ x ry AI Supervisor's Construction License: CS 640 4A8 Exp. Ja#e: 64' 1 0 Iq Home Improvement License: Exp. :Date: l o l off~ oZbly. ARCH ITE CT/ENGI NEER— 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: $ akD. 610 FEE:`$ GCS Check No.: Aff7 Receipt No.: 12�oZi6 NOTE: Persons contracting with unregistered contractors do not have access to theuaran g ty fund Si nature of.. nt/Ownr "F �....f.c g_ -_.. g .eeSi _ gnature_ of contracto i .. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: E IMPORTANT:Applicant must complete all items on this age -177.7071711-7-4 QN`30WNER { r Print � ,,.$11001'ear Old Strno ucture yes 1 0 es IIMAP+NO �AR EL1�. ZONING DTRIC;T:_ istr M chiln ic DShopVillage yes Y 'istriet 'no . e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 1-191s. .t ®1N_eII Floodp(a( i We°tlands © Wat`e s ed Des ict � fJ ®�U1/ater/Sewers DESCRIPTION OF WORK TO BE PERFORMED: C6 Y1 Identification Please Ty a or Print Clearly) OWNER: Name: -1V1 ►4 7.o C-L7 Address:- 0 I ddress:COITRoreb SSupery—ik- C,nst�uction Lei ense ,E'xp, fl6f mpfOvement Li ensu. _ 'A i sE p: r®ate T mow' ARCHITECT/ENGINEER Phone: Address: Reg. No. I FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. 3 'Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Sigriatiare of Agent/Owner ; S�gIature of contractor Plans Submitted ❑ Plans gaived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. 0 '-7 '7— ! 9 Date • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 9l,6e Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check# 26646 rduilding Inspector 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 f Zoning Board",of Appeals-Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments T `r, 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.Stree# Fire Department signxatuve/date COMMENTS r i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF-SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. " .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 '-( I> Signature- L4 COMMENTS_�J� c —��a-�c� [ lov) lc � HEALTH Reviewed on Signature S COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes-.- Planning es .Planning Board Decision: Comments Conservation Decision: Comments Water & Se9iveu`Connection/sl gnature Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIDE'DEPAKTIWENT -Temp Dumpster on site yes no Located at'124 Main"Street" Fire Depari.ib 'it•sigriature/date { COIUMENTS_ 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 r ❑ Notified for pickup - Date I .................................................................................-.............................._.--........--......................................-------.......................................................................................................................................................................................................................................................... I 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 o Workers Comp Affidavit I o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract 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 o Building Permit Application L3 Certified Surveyed Plot Plan ❑ Workers Comp Affidavit - ❑ Photo Co of H.I.C. And C.S.L. i Copy Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan_ And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Li 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.T.C. And C.S.L. Licenses o Workers Comp Affidavit L3 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 q 9 p rtment 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 2008 pORTI1 Town of tAndover of to No. 015 * �-t _ L�M. h , ver, Mass, u COC HIC HI WICM % SAO Q��. '!f R r 5 9s �7ED "� U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System �G�r �� BUILDING INSPECTOR THIS CERTIFIES THAT .................. .. .. .. ..�1............................................... .................................. �/ ` GG �� Foundation has permission to erect .......................... buildings on .............I! .d7...�1.i . Rough ............... l ,� t0 be OCCU S� �yl..�.0.X.�....4�...��..VZO............................................................................ 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 CON STRUCTIO , TARTS Rough .............................. Final 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 Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR i Registration: -s1_ti1510 Type: Expiration: �,W2/,2014 Individual S N R DUFRESNE 1 �f t: SHAWN DUFRESNE �•,� ,pati 5 EQUESTRIAN WAYS MERRIMAC,MA 01860,~ * Undersecretary I" Massachusetts-Department of Public Safety Hoard of Building Regulations and Standards Construction Supen-isor License:CS-065128 r T'r,S • ISHAWN'R DUESNE 5 EQUESTRIiN WAYS Merrimac MO-L 01860 - h 'Expiration Commissioner 04/01/2014 pa & H- _ PROPOSAL Homes and Demolition PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ar NAME ADDRESS- CA. Q ADDRESS I Vo e OV-.F �!I C) N o . A auk/ C�I� PHONE NO. PHONE NO. We hereby propose to furnish the materials anckperform the labor necessary for the rcompl�tion of G 0 X I0 'DeCL kSAC o rncvse o roe came sw Pfr oZ X 1`dta4S PT4'1 c�Wee\�CeicyPSt�a� eSlykx t�0 o SNUACX iubS �A i North Andover MIMAP June 4,-2013 ' rr rwl� e a - <N L Al I , ;3 ` r i a a: • -.._.0__Y -- .. - r r r.> Inleretales In lerslale —Major Roads Hn oesT,oMA.Std c=rT.-' Syskr%Da6x NADS3, Roads Metm Data Su -.The fate t'a 8+s was produced CS'fAe;:irach NORT1y Vaisy Plxa ng Ctrmissar QsT PC{uss g data provided by the Tow n of t Eesememe 0f ,N Norr-Andover.Ad'itvsal dela pnov'ided by Ex Ezau'3re Olfce of ❑MVPC Boundary ? fat a•a 00 Enl e.W`ntat AftTsMtassGIS.The E,f[mat*n depicted on this map is -I Parcels 3' C to.,plan,-Lig purposes only.U may not be adequate for legal boundary F p defk-dwn or regrdavy Werpretat"ron,THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES.EXPRESSED OR IMPLIED,CONCERNING ♦ - >♦ THE ACCURACY.COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF +Aron eA",sj THIS INFORMATION ,SSACMus�t. 1"=15 ft e�r __ I ® DATE(MM/DD/YYYY) .4c - CERTIFICATE OF LIABILITY INSURANCE 7/22 2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: M P ROBERTS INS AGCY INC PHONE (978) 683-8073 wC No:(978) 683-3147 A/C No Ext 1060 Osgood Street E-MAIL ADDRESS:sandi @mproberts insurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:UNDERWRITERS AT LLOYDS INSURED D & H HOMES INSURER 8: SEAN DUFRESNE INSURER C: PO BOX 522 INSURER D: NORTH ANDOVER, MA 01845 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 00,000 I OCCUR PREMISES Ea occurrence $ 100,000 CLAIMS-MADE Ex MED EXP(Any one person) $ 5,000 A LGL1021351 12/16/12 12/18/13 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY GUMBINED 6INGLE 179rr— $ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PR PERTYt DAMA E HIRED AUTOS AUTOS Per acciden $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESRNTAkTIVE M N ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD