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Home My WebLink AboutBuilding Permit #624-14 - 15 HEPATICA DRIVE 3/10/2014 , I pp t TOWN OF NORTH ANDOVER Sot c2 4- VcRW: APPLICATION FOR PLAN EXAMINATION _3j5_ !� Permit NO: U 4 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1-5 �7`G�°/�'7'�ccr� �3�• yM �°ac. - h o Print PROPERTY OWNER_e / J-*� I I Print 100 Year Old Structure yes no MAP NO: I _PARCEL:ZONING DISTRICT: ' L_ Historic District yes n Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building One family 11 Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer Q DESCRIPTION OF WORK TO BE PERFORTED: C'y� � t Ba,� DFF•t��' �ee� . Identification Please Type or Print Clearly) Ide yp Y) OWNER: Name: 11 e q Phone: Address: /V 1jR TJa 01-1116VPtP (M 4 m� s CONTRACTOR Name:!�e Q`146►,-1 C- (QS&00_6 Phone: .� Address: (e cl otg I�,'Ll. � �� h,do0eje M4 m/9y5 Supervisor's Construction License: C S ' O�s3 0 Exp. Date: /.% Jy W Home Improvement License: Exp. Date: ARCHITECT/ENGINEER lkweof-C¢ C�rJeK, Fs Phone: Address: Reg. No. IM FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ .2/. 000. FEE: $ ;Q Sa Check No.: �D�'�y Receipt No.: r'� 3 -0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/O_w �gature of contracto - Plans Submitted ❑ Pla Waived ❑ Certified Plot Plan ❑ Sta ped Plans i Plans Submitted ❑ PlansWaived-0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OYSEWERAGEUSPO, / S�AL Public Sewer u Tanning/Massage/BodyArt ❑. . . Swunming 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 Todv.. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at X124 Main Street Fire Departme t-signatu-'re/date"` t 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 i Doc.Building Permit Revised 2010 Building Department The fohowing 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 Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ 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 ❑ 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) o 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) o Building pp Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 apt).-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 i Location No. W O` Date (J • • TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ v i TOTAL $ `i { Check#�7( Building Inspector i Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 21 X000.00 m $ - $ 252.00 Plumbing Fee $ 31.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 31.50 Total fees collected $ 415.00 15 Hepatica Drive 624-14 on 3/10/2014 Finish Basement, 1/2 Bath And Office Area � fy Town o NORTAndover 0 - ..�.. n No. I j� 4n h ver, Mass, 3 IV _ coc NIc Hews« �- � A TE O PPP`�'�y �S U BOARD OF HEALTH Food/Kitchen PERM ...IT T LD Septic System • THIS CERTIFIES THAT „Gov.,�,......,, +. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...'..,.S........ .. .P.G�.. .....j;X................. an FE050 _ _. . Rough to be occupied as ......... .......... 4, provided that the person accepting this permit shall in every respect conform to the terms of the applicationf9 " 1 7Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough SSS ,3&711 Final �� /,��` a5�. • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIPY ST TS Rou 5Ke_ Service BUILDING INSPECTOR �- GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wali TQ Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner N-�S" Street No. L �� o T �� NORTH Town o . t E . 1, Andover O - �" 0 No. It+ * ver, Mass, 3 (� COCNICKl WICK x.45 RATED I.PP��,�S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......................... ......................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... ........ .. .. .i> ,►..I - .....��►c.................. P Rough to be occupied as ......... .......... .....WAi& .....Q.V . ......1 .................. ........ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final a5� . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST TS Rough Service .............. ........... .. .:.............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dr Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction Super%isnr License: CS-075302 BENJAMIN C OSODO 69 OLD VILLAGE NO ANDOVER Nf.4 0 A Expiratior Commissioner 12/04/2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers insurance ComlpanY 54 Third Avenue, Burlington,Massachusetts 011803-0970 N (8Q0)876-2765 CCI NO 40959 POLICY NO. WCC-500-5007581-2013A PRIOR NO. 11NCC5007581012012 I ITEM 1. The insured: Key Lime Inc D&4: FEIN:**-***1218 Mailing address: joHeaticaDrive North Andover, MA 01845 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 09/15/2013 to 09/15/2014 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states 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 liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident j Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premlum INTRA 285896 INTER SEE CLASS CODE SCHEDU Minimum Premium $575 Total Estimated Annual Premium $4,470 GOV 1 GOV Deposit Premium STATEiCLASS MA 1 5645 MA Assessment Chg. $169 This policy, including all endorsements,is hereby countersigned by' f/L� va 07/23/2013 Authorized signature Date Service Office: M P Roberts insurance Agency 54 Third Avenue 1060 Osgood Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-111) includes copyrighted materiel of the National council on Compensation Insurance, used with its permission.