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Home My WebLink AboutBuilding Permit #297 - 151 OLYMPIC LANE 10/16/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION t F- _ A Permit NO: Date Received r 's b P � y Date Issued. 9 � s SACHUSE IMPORTANT:"Applicant must complete all items on this page LOCATION 15 Z-�1161P /G L41,1/Z Print PROPERTY OWNER /3 0 L h T l�i/y S P 1\1 Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family 11 Addition ❑ Two or more family ❑ Industrial Alteration No. of units: )<Re air, replacement P p u Assessory Bldg ❑Commercial i Demolition Moving(relocation) ❑Other ❑ Others: i Foundation onl DESCRIPTION OF WORK TO BE PREFORMED / Jz P L h C r7 Jy is 1,1T r I C T-v 2 i k, /',11) % k,1 Identification Please Type or Print Clearly) OWNER: Name: 6 L 1`iz j O EV 1, q. /V Phone: `� 7e cP/ ec13y Address: / 6 /rP P x k CONTRACTOR Name:_ _ f C W r`D L o tl !-t S 3 U RY Phone• �9 ')d' y97S�r`/J3 Address: A 6 60 f, L Q jl D Supervisor's Construction License: OS-S`y Exp. Date: �2 `7 /6 d� Flome Improvement License: J G 0 V�.�' Exp. Date: C, A5- A � ARCHITECT/ENGINEER Name: Phone: lddress: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER.8'1000.00 OF THE TOTAL ESTIMATED COST BASED ON S125.00 PER S.F. Total Project Cost :$ % b w' FEE:$ fd j Check No.: Receipt No.: (� I'•i;,'e lof4 TYPE OF SEWERAGE DISPOSAL Swimming Pools G Tanning/Massage/Body Art ❑ g Public Sewer Tobacco Sales Well 'JI Food Packaging/Sales Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to titVtaedjPlans iend Signature of Agent/Owner Signature of contractG Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ -COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date P - COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Sii!nature& Date Driveway Permit I Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: NOTES and DATA— For department use ' I I I i i Pa,c 3 uf-1 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS OcaledJKIC 1:m.006 II I Building Department The following is a list of the required forms to be filled out for theappropriate obtained. permit to be 1 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 Addition Or Decks i ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C.C And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic CalculationsIf Applicable) ( pP e) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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 DEPARTN1EN'r:UPF0RN1115 Page 4 of 4 F q Location ��,�/-z- l�'✓"�" ` ' r k` No. °1 Date k NORM TOWN OF NORTH ANDOVER FIk. 9 : : Certificate of Occupancy $ sA�* ��' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ rr Check #,5,r/, 19690 Building Inspector r it Vk®RTly ON VM 0 Andover 0 No. 297 _ T O �y�- L AK E o � over, Mass. COCHICHEWICK ,'t' %d ADRATED PPS\ -`y 7S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT......... .. .' ...................Il j! j^,..................................................... BUILDING INSPECTOR Foundation . has permission to erect............. buildings son �......�.l. ,��..,G......... ./......1 W4.. Rough to be occupied-as.ar......wxmf . .............. .. . .. ... re��"ftihiie_ Chimney Ch' e provided that the person accepting this permit shall in every r.. lett conform to thapplication on file in Final 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 01rIT PERMEXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough ...................... ..... ........... ....... ............... ... .. . ... . .. . ............. ....... ....... Service BUILDING INSPECTOR 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. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR I Registration: 100265 i Expiration:--6/1512008 Type.: Individual =i RICHARD LOUNSBURYL' a .� Richard Lounsbury 106 Gould Rd Andover.MA 01810 Denuty Administrator � _ 01 _ e •4s a co YGEs� 1,iy 0�ll G��O� 9 05 O 0,319 00 0 ca 05 lk sG9 31211 4 bci s O � D s a j Page No. of Pages Prop RICHARD LOUNSBURY Re& #100265 10£ Could Road ANDOVER, MM-)SPCHUSETTIS 01810 (978) 475.4 .31 PROPOSAL SUBMITTED Tb1-*"11'. � PHONE DATE _ ` A< STREET " /� JOB NAME 2 Le CITY,STATE and ZIP CODE s JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE yge6el j We hereby submit specifications and estimates for: We praPUSP hereby to furnish material and labor—complete in accordance With above specifications, for the sum of: Payment to be made as follows: (J dollars($ 00,: ). (f U0 6:"o 1' . < All mlferial is guaranteed to be as specified. All work to be compl'eeted a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature v charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within 'd days. Arreptanre of Proposal —The above prices, specifications (/Y and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Paymentwill be made as outlined abo e. Date of Acceptance:— �_ — 0 Signature NORFOLK AND DEDHAM MUTUAL FIRE INSURANCE COMPANY SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE PO4Cy # R080B533A Agent TYRRELL INSURANCE AGENCY, INC. Named RICHARD LQUNSBURY Phone Ensured 105 GOULD RD 9 B 371- 0 Agent # 20726 ANDOVER MA 01810 FORM OF BUSINLSS: _ Policy Period ONE YEAR from 04/28/06 t0 04/28/07 This declarations page together with thepc►licy jacket, the policy form. and any endorsements, completes this policy. Coverage begins at 12:01 A.M. Standard 'Time at the covered premises. 777777.. ,; POLICY PRM � � �' � Basic Annual EndorsementsState Taxes i Total Annual Add'I/Return Pr him EEMMI[IM $1, 197 , $1 , 19? —! Bldg./Location _1 1 105 GOULD RD ANDOVER MA 01810 Address if Different— Mortgagee Information ' Business Description ICARPENTRY 77777777777777777777777--- Tremiaam� POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Included TOTAL PREMIUM PER BUILDING $1, 197.00 — — EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT or INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH DA OF THE BUSINESS i LIABILITY COVERAGE FORM. r LIAB & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGG) $1,000/ $2,000/ $2,000 Included MEDICAL EXPENSES $5 Included DAMAGE TO PREMISES RENTED TO YOU $50 Included SEE ATTACHED PAGE i loiO;I TW<,O00CY ' 8OV1SIONS R. Cr1UN C7=�tSI AU HFJiitZ b'I'IEP E Et5ETA1'11�E MINIMl3M #iFMiR1M 'CWARG tVOR1lALLY :APPLIES IF Y+DU CAISra CSI, t�gilC1E1 'C frXP11A1'ION.:DATE, WS SWALL fTAiN AT 1.EAS1' r,r Sf >AWAR LeSt bf TERM .„ „• .V4 ' .w✓' ai, k ... 77 77— Hop-z BOP-24/05) Type of Payment: DIRECT BILL 4 PAY