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HomeMy WebLinkAboutBuilding Permit #16 - 16 DUFTON COURT 7/9/2007 NORTH BUILDING PERMIT °�<t`" TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received °AAT■° s�� ��SSAc►+u Date Issued:' 0 IMPORTANT Applicant must complete all items on this page 14 x : EQ �" •: a ? z a z 5 1 - ns {"'ROio a TRICE nn MAP0 TRITE. Ye TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ A ' ion �o or more family [I Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p � aaf ;";Iv�Aot .< C �'ptlG, i Y13fq ilta i, Jg,n, .� f it DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: OG- Q Phone: Address: `r/a ,Z�ur7"v�/ / D 19,AlL ae� /"7l3 > a grse ' 'ONT1 7t R Nat e 44, w " Ad .: ° . < 4, 41 Ty Z ? 4 k :• 5u,per�rsd�rratrtrs� ' =------ 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. J- --Total Project Cost: $ 0 a U FEE: $ V Check No.: 3 Y7— Receipt No.: 'Vy1319_ NOTE: Persons contracting with unregistered contractors do not have access the g aranty and Signature of contractor. Signature of Agent/Owner v ` Location A No. Date 7 NORTH TOWN OF NORTH ANDOVER • ; Certificate of Occupancy $ • 3 �'�sJ•"e'ttn Building/Frame Permit Fee $ CH 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 2015 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I I DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH DATE REJECTED DATE APPROVED ❑ ❑ COMMENTS 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 ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/si nature Date I Located at 384 Osgood Street Drivewa i Permit FIRE 1EhARTMEt�T Tem Dum step ora std p � 71 Located at 24�Mair S#reet� 0 t1 '` � 9nattrefdate >, ,� mx 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 a ❑ Notified for pickup - Date I 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 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 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 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 2.2007 CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Samuel J Durso Insurance DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Agency Inc 198 Mass Ave Suite 101B COMPANIES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh COMPANY dba A. J. Walsh&Sons LETTER A A.I.M. Mutual Insurance Co 55 Pleasant Street North Andover, MA 01845 COVERAGES 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 RESPECTTO 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADE[::�CCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM X WSTATU- OTH- WORKER'S COMPENSATION AND TORC Y LIMITS ER EMPLOYERS'LIABILITY 7014648012006 11/14/2006 11/14/2007 EL EACH IDENT $ A THE PROPRIETOR/ INCL EL DISEASE--POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: X EXCL EL DISEASE—EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Ilie commonweatin of 1vlussucrlu6Clw Department of Industrial Accidents Vi I Office of Investigations . d 600 Washington Street Boston, MM 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le14MV Name (Business/Organization/Individual): � / S iT s ON Address: /945 "— I ! City/State/Zip: �qlyy?D 1/(f R /41fi Phone #: q-7Y-6XP—03-7 Are you an employer? Check the appropriate, l Type of project(required): 1. ❑ I am a employer with 4. a general contractor and I 6. ❑ New construction art-time) employees full and/or .* have hired the sub-contractors ( p listed on the attached sheet 1 emodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have.exercised their 3.F] I am a homeowner doing all work right of exemption per MGL 11.[:] Plumbing repairs or additions ,152 , and we have no myself. [No workers' comp. c. §14( ) 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. / /1d� J v _ Insurance Company Name: /j / /� t ✓W1w� ` /�`s c b Policy#or Self-ins. Lic. #: S� 7y 6 12,00-1 Expiration Date: Job Site Address: l �� 770 A/ C l City/State/Zip: le AAO Z M A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against.the violat6r:- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverago.verificatioia. I do hereby certA under the pains and penalties of pe►jury that the information provided above is true and correct Signature: Date: tP Phone#: %������ 45 Oficial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: +!' ✓,/ie zoonrmwnuiecr�l� o�✓�uW6aa�eude�ld BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numt '6�S 022680 BI - (/1939 06 Tr.no: 71.0 ARTHURJ WA 7 55 PLEASANT S N ANDOVER, MA A' Commissioner �' ? � - fee Va�nnna�zuiea�i a� 1 Board-ofB ildinE ReEuLpoas and taa qq1 ,HOME IINPROVIR •* � .Corporatlon` Cad [�;! y li LSH A C u r t Propool Pae# of pages CS # 022680 978-688-6737" HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: Job Name /� -T ob# Address + Job Location Date G Date of Plans Phone If r ( Fax# _ f Architect rrWe hereby submit specifications and estimates for: We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: tjO $ / a�G Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by vs if not accepted withitt/ days. Rcceptance of Propool The above prices,specifications and conditions are satisfactory and are � I nnatu e r �g hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature t%0RTjj Town of Andover No. 0 dover, Mass., 1p 1., 0 0 � Ap COCHICHEWICK , 0RATE D '9� C7 BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT...... ..4r...... .................... Foundation has permission to a buildings on /4........ Rough cr........................... Chimney to be occupied as..... .... .. ...... .......... y respect conform to the terms of the application on file in Final P rovided that the person a**c"c*'e"p*t'ln*g"i�i:e�pie.rm shall in eve e-.r-. .............................................................. 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 PERMIT EXPIRESN Final UNLESS CONSTRUP02NA's oe ELECTRICAL INSPECTOR woo 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.