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HomeMy WebLinkAboutBuilding Permit #606 - 155 BARKER STREET 5/12/2009 BUILDING PERMIT O* t►o oTh qti TOWN OF NORTH ANDOVER 02 °�� *6*° �°^, APPLICATION FOR PLAN EXAMINATION ^O 4y Permit NO: Date Received '1f,9 p°gwra° SSACHUS� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION nn PROPERTY OWNER Print MAP NO: _ PARCEL:-(�J�f/ 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 No. of units: Commercial Repair, replacement X Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: &- PLAcrz- =-!°t'S"�` t el� Com` i 1 Ow s ` A S f Rlfio�oo� 4sn�lin,� Identification Please Type or Print Clearly) OWNER: Name:—TO 6-- C14AiPhone: l7 K415'3/ Address: �5' B A,ZCi0— JT— P, Ah Dour_=2 m CONTRACTOR Name: lC.i C-4 ,4 2 L rr �S� Phone: 4.� Address: /(n /,A w P cn c6: R o A /y Supervisor's Construction License: C5 029 Q Exp. Date: C; Home Improvement License: 2 // 3S7 Exp. Date: f�o 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: $ �f `1 S �-O FEE: $ Check No.:__ _ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor �� Location No. 606 Date f, t d�1 NORM TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ cMuBuilding/Frame/Frame Permit Fee $ y� s� sa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /y f s l 22Uzl Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL l 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 i f I CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning,B.oard Decision: Comments I I i Conservation Decision: Comments f Water & Sewer Connection/Signature& Date Driveway Permit I 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 i 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NO NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 r 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 ConstructionSin le and Two Family) � 9 Y) ❑ 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 DEPARTMENTMFORM07 Revised 2.2008 MAY-12-2099 09:13A FROM: 70:19786889642 P.1/1 mmwffm A�' CERTIFICATE OF LIABILITY05112112009 PRODUDeRTMS CFJtTFfCAT1 IS ISSUEDA MATTER OF INFORMATION The Insurance Doctor ONLY ER O UPON THE ClIFICATE "OLDER. THIS CORTIFICATE DOES NOT AMEND. EXTEND OR 453 Second Street ALTER IM Cr"=Atle AFFOROEDBY THE POLICIES BELOW. Manchester.NH 03102 -1.-' INSURES AFFORDING COVERAGE NAIC p uRauREo Tre"1014 Inswence, Richard Keyes 11 BNSu 16 Lawrence Rd u C: Salem,NH 03079-3237 u EusuRER COVERAGES THEPOUCIES OF I NSURANCE LISTEDBELOW HAVEBEEN I SSUEDTOTHEINSUREDNAMEDABOVE FORTHE POLICYPERIOD IND ICATED,NOTWITHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAYPERTAMI,THE INSURANCEAFFORDEDBYTHEPOLICIESDESCMBEDHEREINIS SUBJECTTOALLTHETERMS.O(CLUSIONSANDCONDMONSOFSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'I MOR AWL POLICY NUMBER POLICYDATRIMEM ME= }� GENERAL LIABILITY SACE OCCURRENCE% DAMAGE TO RENTED COMMERCIIL GENERAL LIABILITY acal— C MADE ❑OCCUR D EXP one penem IS 10 � I Pe 14AL&ADVIWJRY GENERAL ASG TE AGG E LIMIT APPLIES PER: PRO P RYE �J POLICY PRO- MLOC --T AUTOAPAU LIABILITY COMBINED SINGLE LOW f kiC ANY AUTO IEa acdowl) ALL OWNED AUTOS !" GODLY MJURY SCNWULEOAUTOS (Par person) s �- HREDAUTOSINJURY NOWOWNED AUTOS IPM M , GARAGE L"LRY AUTO ONLY-EA ACCIDENTt ANYAUTO OTHERTHAN CC •�+ AUTO ONLY: AGG EXCEEB I UMBRELLA LIABILITY EACHMCURRENCE " OCCUR 0 CLAIMS MADE REGA t; fr DEDUCTIBLE RETENTION I WORKERS COMPONSATION x WC STATU OTH- AND EMPLOYERS LIABILITY A ER A ANY PRDPracToR;;wmzw�cunv ;; 74"13133 0410912009 04-09=10 E.L A c 100, OFFICERN(MmMatery I t UHR EXCLUDv:D7 , t L D .ASE-E 6 101000 Me= I,DISEASE order -POLICY LIMIT sS00'000 OTHER DEOCIWMN of GPERATIONO I LOCATIONB I WMLBS I MMUSMI AODW eY ENDORBEnENT 10PECML PRWIIIONO CERTIFICATE HOLDER CANCELLATION SMWLDANYOPTHEAB0IBDENROMPOUCIEBaECANCELLEDSWORBTIR KPMA ON City of North Andover Massachusetts DATE THEREOF,THE ISSUING INSURER WILL ENOL AYOR TO MAIL DAYS WRITTEN 1600 Osgood Street HOUR TO THE CEImMATE HOLDER NAMED TO THE LEFT,OUT FAILURE To 00 50 SMALL Bldg 020 Ste 2-36 sums No OBLIGATION OR LIANAM OF ANY KIND UPON THE INSURER,rre AGENTS OR North Andover,MA 01845 EFR EN ATAn?O ` A1tED REFRE - �t;s ACORD 25(2009101) 019 009 A RD CORPORATION. All rip 88c served. The ACORD name and logo are registered marks of ACORD NORTH Town o _ over . 0 No. 6 a i = over, Mass., O -- L A E coC NICKEWICK 7�ADRATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT _ ......................................................... �........................................................................................... Foundation /L ✓ � .. ...... 1 has permission to erect........................................ buildings on ........................ .. .... ............ Rough 25 to be occupied as..............�"�. ,/..���t.�c .. .� ^?: GN. �Lf. G'�e✓ ..............% ... © ............................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough t ................ .......... <-gj�UILD­ lService ING'ZNSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough j Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done ■ � FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1 I } 71. card of Building Regulations and Standards onstruction Supervisor License i Lice.rfise CS 29328 Birthdate__9/:11/1958 =E •piratbon—9f1.12009 Tr# 4158 =- — RICHARD L KEY ES IIS 16 LAWRENCE RD z��5 SALEM,NH 03079 Commissioner ✓�ze -r�anvino�u�,all� a�../�aaaacticcael�a , Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 124135 Expiration:�51116/2011 Tr# 282876 p nI dividual• i Richard L.Keyes 11 }._. .- Richard Keyes,IF 16 Lawrence rd. Salem, NH 03079 ' S, Administrator f f I f �tageyes Sold Throughout New England By ��6eantrae�'°s� Richard Keyes H & Sons VINYL REPLACEMENT WINDOWS MAIN OFFICE 893-3560 Salem, N.H. 893-1213 I/We,the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described,with reference to which we warrant we are the record holders of title. Owner's Name ...........'.......... ....� ..... ......................................... , ...t..... Tel. ...!.............. ........ Job Address ...!. ...1,=`Z( t'o�......ST....... .................City..'�.. :1CALUr/.—.....State... . �� .................. -5!...!.,�•A>.'. ....t. ^r, t l _nit o+ Na '� _ ft' r - .................... _ J fX,,1 j ZnM....a�...................... ......!............�.. �P<f.t'.... � ........ t,;�F•r GLam. uOtft,r' . Cr�j1 ., tk<<�t ,; r,2 SC f,.' �( ................... ..........: ....!. ............................... .. .. ....+.A-r b...�o.............•.-!..... ...(�, .r..o....��, �2...... <. (o.._ wh+.'.!may...: ti .F.. '. ..,lr j....... 1...2..x . <<4. ,.jji-: !.?�....dU(�'I <I 'C /4 L: n X, 7e 1 j ( Qt--.;X000 /l._ r' .Yl V ..... .. .. .. ....... ....a.................. . . ..................!`...:.'....:.....:........x.1. 1. p .-....,�t�rt� 1.L..�.A�-)c),l k� n-2A �,tr'NI-.f..�.K:..:.r.l�( O��A}� h,'':�_tit(;,L f.��, r.2/,�........... ..l E'....�..`...`....�R-�•........ .Q�.��. ...�!J','� >'i�l� t1" V �! ..'.,..5..�.n.�4��.5 .....��. ._.. f f............................... .........................�...F ........... ................................................................. .................................................................. Amount $ �� t of flyde Down $ 1 `�1 l J/' � 1� ur Payment Balance $ f, Cash V Contractor will do all of said work in a good workmanlike manner.Upon written notification from the owner of a defect in workmanship or material,the contractor will repair the same if such a defect exists but in no event shall the contractor be liable beyond the cost to it of labor and materials. The owner hereby certifies that he has read this agreement,that the terms and conditions and the meaning thereof have been explained to him and that he fully understands them:That there is no understanding between the parties verbal or otherwise than that contained in this agreement,and that the owner shall maintain no action on any new substituted contract except the same be in writing,and that no statements,promises,commitments or representations not contained in this agreement have been made by the contractor,or by any of his agents to induce him to execute this agreement,and agrees that said contractor is not responsible nor bound by any representations not contained in this agreement made by any of its agents,unless the same be reduced to writing and signed by contractor.You may cancel this agreement if it has been consummated by a party thereto at a place other than an address of the seller,which may be his main office or branch therof,by a written notice directed to the seller at his main or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. t1 / (1 INCESS WHEREOF,the parties have hereunto signed their names this ...! �................ day of ..- ?<.............,19..,,.�� .~.......... 1.... �� .............................. Signed .................................................................. 'Representative Owner Accepted: Signed ....\....... , ....................................................... Contractor may assign this agreement. ,Owner,